Provider Demographics
NPI:1578570172
Name:SINGH, SURJIT (MD)
Entity Type:Individual
Prefix:
First Name:SURJIT
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 1:3642 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-5543
Mailing Address - Country:US
Mailing Address - Phone:812-234-7945
Mailing Address - Fax:812-234-6059
Practice Address - Street 1:620 8TH AVE
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47804-2771
Practice Address - Country:US
Practice Address - Phone:812-231-8323
Practice Address - Fax:812-231-8400
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01035135A2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN351922803OtherETIN
IN260035446OtherRAILROAD MEDICARE #
IN000000090264OtherBLUECROSS BLUESHIELD PIN
IN079099000OtherMAGELLAN PROVIDER #
IN200093240AMedicaid