Provider Demographics
NPI:1780661843
Name:SANGHA, SIMREN (MD)
Entity type:Individual
Prefix:
First Name:SIMREN
Middle Name:
Last Name:SANGHA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 YORK ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3220
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20 YORK ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3220
Practice Address - Country:US
Practice Address - Phone:203-737-8898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA220257207R00000X, 207RG0100X
CT78977207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2064740Medicaid
MA92323OtherFALLON COMM HEALTH PLAN
MAAA13429OtherHARVARD PILGRIM
MA469209OtherTUFTS HEALTH PLAN
MA0036424OtherNEIGHBORHOOD HEALTH PLAN
MAJ27568OtherBLUE CROSS BLUE SHIELD
MA92323OtherFALLON COMM HEALTH PLAN
MAAA13429OtherHARVARD PILGRIM
MA469209OtherTUFTS HEALTH PLAN