1891882635 NPI number — SUE ELLEN SINGH PA

Table of content: SUE ELLEN SINGH PA (NPI 1891882635)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891882635 NPI number — SUE ELLEN SINGH PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SINGH
Provider First Name:
SUE
Provider Middle Name:
ELLEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891882635
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/28/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2000 FRONTIS PLAZA BLVD STE 200
Provider Second Line Business Mailing Address:
NOVANT MEDICAL GROUP
Provider Business Mailing Address City Name:
WINSTON SALEM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27103-5616
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-277-2435
Provider Business Mailing Address Fax Number:
336-277-9275

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5010 PETERS CREEK PKWY
Provider Second Line Business Practice Location Address:
DBA FRIEDBERG FAMILY MEDICINE
Provider Business Practice Location Address City Name:
WINSTON SALEM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27127-7276
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-788-4664
Provider Business Practice Location Address Fax Number:
336-788-0753
Provider Enumeration Date:
10/05/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  101551 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)