=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942506175
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRITAM SINGH, MD, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/05/2011
-----------------------------------------------------
Last Update Date | 02/07/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 735 E OHIO AVE STE 204
-----------------------------------------------------
City | ESCONDIDO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92025-3437
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-743-1033
-----------------------------------------------------
Fax | 760-480-1015
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 735 E OHIO AVE STE 204
-----------------------------------------------------
City | ESCONDIDO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92025-3437
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-743-1033
-----------------------------------------------------
Fax | 760-480-1015
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING MANAGER
-----------------------------------------------------
Name | KIM M GORMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 619-271-9688
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | A32134
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------