Healthcare Provider Details

I. General information

NPI: 1154070316
Provider Name (Legal Business Name): BRIAN SINGH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 DEERPATH
CHARLESTON IL
61920-9427
US

IV. Provider business mailing address

2608 SIEGEL CT
PLAINFIELD IL
60586-9165
US

V. Phone/Fax

Practice location:
  • Phone: 302-542-9612
  • Fax:
Mailing address:
  • Phone: 302-542-9612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMT225400
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number0101286354
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: