Provider Demographics
NPI:1235122649
Name:SINGH, BRAJENDRA P (MD)
Entity Type:Individual
Prefix:DR
First Name:BRAJENDRA
Middle Name:P
Last Name:SINGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:311 S MCNEIL ST
Mailing Address - Street 2:PO BOX 1299
Mailing Address - City:BURGAW
Mailing Address - State:NC
Mailing Address - Zip Code:28425-5015
Mailing Address - Country:US
Mailing Address - Phone:910-259-3377
Mailing Address - Fax:910-259-3013
Practice Address - Street 1:311 S MCNEIL ST
Practice Address - Street 2:
Practice Address - City:BURGAW
Practice Address - State:NC
Practice Address - Zip Code:28425-5015
Practice Address - Country:US
Practice Address - Phone:910-259-3377
Practice Address - Fax:910-259-3013
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28805207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC60018905OtherTAT NUMBER
NC76548OtherBCBS
NC010018498OtherRAIL ROAD MEDICARE
NC34D0245916OtherCLIA NUMBER
NC8976548Medicaid
NC203728Medicare PIN
NC76548OtherBCBS
NC010018498OtherRAIL ROAD MEDICARE