Healthcare Provider Details

I. General information

NPI: 1801996079
Provider Name (Legal Business Name): MANAV SINGLA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 10/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5430 CAMPBELL BLVD SUITE 103
WHITE MARSH MD
21162-5500
US

IV. Provider business mailing address

5430 CAMPBELL BOULEVARD SUITE 103
WHITE MARSH MD
21162-5503
US

V. Phone/Fax

Practice location:
  • Phone: 410-933-9404
  • Fax: 410-933-9405
Mailing address:
  • Phone: 410-933-9404
  • Fax: 410-933-9405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberD62592
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License NumberD62592
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: