Provider Demographics
NPI:1134110166
Name:SINGH, AJIT (MD)
Entity Type:Individual
Prefix:DR
First Name:AJIT
Middle Name:
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 1:4757 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-4559
Mailing Address - Country:US
Mailing Address - Phone:812-234-2289
Mailing Address - Fax:812-232-4234
Practice Address - Street 1:4757 S 7TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-4559
Practice Address - Country:US
Practice Address - Phone:812-234-2289
Practice Address - Fax:812-232-4234
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01058116A208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200490870Medicaid
IN176980GMedicare ID - Type UnspecifiedINDIVIDUAL #
IN136610GMedicare ID - Type UnspecifiedINDIVIDUAL #
IN176980Medicare ID - Type UnspecifiedGROUP #
IN136610Medicare ID - Type UnspecifiedGROUP #
IN200490870Medicaid