Provider Demographics
NPI:1114985686
Name:SINGH, JASVINDER PAL (MD)
Entity Type:Individual
Prefix:DR
First Name:JASVINDER
Middle Name:PAL
Last Name:SINGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 N ROAD ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-3243
Mailing Address - Country:US
Mailing Address - Phone:252-338-6167
Mailing Address - Fax:252-334-1755
Practice Address - Street 1:1507 N ROAD ST
Practice Address - Street 2:SUITE 1
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-3243
Practice Address - Country:US
Practice Address - Phone:252-338-6167
Practice Address - Fax:252-334-1755
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33893207RP1001X, 207RS0012X, 207RC0200X, 207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890173XMedicaid
NC4854877OtherUNITED HEALTH CARE
NC690280QMedicaid
NC891038TMedicaid
NC1038TOtherBCBS OF NC PROVIDER #
NC0173XOtherBCBS OF NC GROUP #
2327994OtherPTAN-MEDICARE
2164379BOtherMEDICARE
NC437123OtherALLIANCE PPO
NC891038TMedicaid