Provider Demographics
NPI:1558308452
Name:DEBSIKDAR, JAIDEEP (MD)
Entity Type:Individual
Prefix:DR
First Name:JAIDEEP
Middle Name:
Last Name:DEBSIKDAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JAIDEEP
Other - Middle Name:
Other - Last Name:DEBSIKDAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8603
Mailing Address - Fax:
Practice Address - Street 1:115 N SUMTER ST STE 410
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4969
Practice Address - Country:US
Practice Address - Phone:803-774-9797
Practice Address - Fax:803-933-3012
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0090-00540207R00000X
SC36675207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC366758Medicaid
NC58-2569828OtherUNITED HEALTHCARE
NC7453359OtherAETNA
TN7393801OtherAETNA