Provider Demographics
NPI:1609987684
Name:SHEKHAWAT, PREM SINGH (MD)
Entity Type:Individual
Prefix:
First Name:PREM
Middle Name:SINGH
Last Name:SHEKHAWAT
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 751069
Mailing Address - Street 2:ECU PHYSICIANS NEONATAL CHILDREN'S HOSPITAL 227
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 MOYE BLVD
Practice Address - Street 2:ECU PHYSICIANS NEONATAL CHILDREN'S HOSPITAL 227
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-4300
Practice Address - Country:US
Practice Address - Phone:252-744-0766
Practice Address - Fax:252-744-0392
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0500592080N0001X
NC2011-016662080N0001X
OH35.0914982080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000904505AMedicaid
NC167GFOtherBCBSNC
NC5919280Medicaid
SCG50059Medicaid
GA37BBFWBMedicare ID - Type UnspecifiedGA MEDICARE
NC5919280Medicaid
NCNC44180322Medicare PIN