Provider Demographics
NPI:1053732594
Name:SINGH, GLENDA J
Entity type:Individual
Prefix:
First Name:GLENDA
Middle Name:J
Last Name:SINGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5006 OAKBROOK RD
Mailing Address - Street 2:C
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-1137
Mailing Address - Country:US
Mailing Address - Phone:317-280-7499
Mailing Address - Fax:
Practice Address - Street 1:5006 OAKBROOK RD
Practice Address - Street 2:C
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-1137
Practice Address - Country:US
Practice Address - Phone:317-280-7499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-31
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN8920-882722347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
INN/AOtherNOT APPLICABLE