Provider Demographics
NPI:1568562940
Name:SANDHU, JAGJIT S (MD)
Entity Type:Individual
Prefix:DR
First Name:JAGJIT
Middle Name:S
Last Name:SANDHU
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:PO BOX 218
Mailing Address - Street 2:1508 MAIN ST
Mailing Address - City:RAMSEUR
Mailing Address - State:NC
Mailing Address - Zip Code:27316-0218
Mailing Address - Country:US
Mailing Address - Phone:336-824-2255
Mailing Address - Fax:336-824-8333
Practice Address - Street 1:1508 MAIN STREET
Practice Address - Street 2:
Practice Address - City:RAMSEUR
Practice Address - State:NC
Practice Address - Zip Code:27316-0218
Practice Address - Country:US
Practice Address - Phone:336-824-2255
Practice Address - Fax:336-824-8333
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23232207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC74475OtherBCBS
NC790259PMedicaid
NC8974475Medicaid
2342919Medicare ID - Type Unspecified
NC8974475Medicaid