Provider Demographics
NPI:1891882635
Name:SINGH, SUE ELLEN (PA)
Entity type:Individual
Prefix:
First Name:SUE
Middle Name:ELLEN
Last Name:SINGH
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:2000 FRONTIS PLAZA BLVD STE 200
Mailing Address - Street 2:NOVANT MEDICAL GROUP
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-5616
Mailing Address - Country:US
Mailing Address - Phone:336-277-2435
Mailing Address - Fax:336-277-9275
Practice Address - Street 1:5010 PETERS CREEK PKWY
Practice Address - Street 2:DBA FRIEDBERG FAMILY MEDICINE
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-7276
Practice Address - Country:US
Practice Address - Phone:336-788-4664
Practice Address - Fax:336-788-0753
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2020-10-28
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Provider Licenses
StateLicense IDTaxonomies
NC101551363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2748955AMedicare PIN
NCS68767Medicare UPIN
NC2748955Medicare ID - Type Unspecified