Provider Demographics
NPI:1578562955
Name:CHANDI, TEJWANT SINGH (MD)
Entity Type:Individual
Prefix:DR
First Name:TEJWANT
Middle Name:SINGH
Last Name:CHANDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1507 N ROAD ST
Mailing Address - Street 2:STE 3
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-3243
Mailing Address - Country:US
Mailing Address - Phone:252-335-2963
Mailing Address - Fax:252-335-2636
Practice Address - Street 1:1507 N ROAD ST
Practice Address - Street 2:STE 3
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-3243
Practice Address - Country:US
Practice Address - Phone:252-335-2963
Practice Address - Fax:252-335-2636
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9701713207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
111692OtherSENTARA
2261582AOtherMEDICARE
29476OtherSENTARA
NC891170CMedicaid
VA432487OtherBCBS
2344538OtherMEDICARE
7203205OtherCIGNA
295434OtherMAMSI
PR72032050001OtherCIGNA
NC1170COtherBCBS
NC89011F5Medicaid
96698OtherMEDCOST
110213096OtherMEDICARE RR RETIREMENT
26741OtherPARTNERS
522238390OtherUNITED HEALTHCARE
522238390OtherFIRST HEALTH
E52223839091229OtherAETNA US HEALTHCARE
2261582AOtherMEDICARE
7203205OtherCIGNA
96698OtherMEDCOST