1629052691 NPI number — PARDUMAN SINGH MD

Table of content: PARDUMAN SINGH MD (NPI 1629052691)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629052691 NPI number — PARDUMAN SINGH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SINGH
Provider First Name:
PARDUMAN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1629052691
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4610 TRADEMARK TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HILLIARD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43026-7481
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-402-3894
Provider Business Mailing Address Fax Number:
330-793-3313

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4610 TRADEMARK TRL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HILLIARD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43026-7481
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-402-3894
Provider Business Practice Location Address Fax Number:
330-793-3313
Provider Enumeration Date:
12/02/2005

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: 2084N0400X , with the licence number:  35047526S , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0511066 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000291637 . This is a "OH MEDICAID UNISON" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 310917085221 . This is a "OH MEDICAID CARESOURCE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0511066 . This is a "OH MEDCAID MOLINA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 3810016754 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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