Basic Information
| Provider Information | |||||||||
| NPI: | 1013103696 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SINGH | ||||||||
| FirstName: | POONAM | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 215 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 424501261 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2706677017 | ||||||||
| FaxNumber: | 2706679065 | ||||||||
| Practice Location | |||||||||
| Address1: | 1402 N HIGH ST | ||||||||
| Address2: | |||||||||
| City: | HILLSBORO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 451338514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9373934899 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2007 | ||||||||
| LastUpdateDate: | 10/31/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | BP20027448 | TX | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 41726 | KY | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 7100040140 | 05 | KY | MEDICAID |