Basic Information
| Provider Information | |||||||||
| NPI: | 1174838353 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BALDEV SINGH MD FCCP INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 991844 | ||||||||
| Address2: | |||||||||
| City: | REDDING | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960991844 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5302469806 | ||||||||
| FaxNumber: | 5302469808 | ||||||||
| Practice Location | |||||||||
| Address1: | 2425 SAMARITAN DR | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951243908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4085592100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2010 | ||||||||
| LastUpdateDate: | 08/12/2010 | ||||||||
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| AuthorizedOfficialLastName: | SINGH | ||||||||
| AuthorizedOfficialFirstName: | BALDEV | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4084406415 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | C50183 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00C501830 | 05 | CA | MEDICAID | 1992717953 | 01 | CA | NPI TYPE 1 | OTHER |