Provider Demographics
NPI:1598709727
Name:SINGH, VIJAY R (MD)
Entity Type:Individual
Prefix:
First Name:VIJAY
Middle Name:R
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 1:1201 N WILCOX DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4967
Mailing Address - Country:US
Mailing Address - Phone:423-245-1560
Mailing Address - Fax:423-392-1153
Practice Address - Street 1:1201 N WILCOX DR
Practice Address - Street 2:SUITE B
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4967
Practice Address - Country:US
Practice Address - Phone:423-245-1560
Practice Address - Fax:423-392-1153
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38182207P00000X, 208M00000X
TNMD0000038182207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100045610Medicaid
VA1598709727Medicaid
TN38923051Medicaid
TN3892306Medicaid
TN38923051Medicaid
TN3892306Medicaid
KY7100045610Medicaid
TN38923051Medicare PIN