Provider Demographics
NPI:1689954059
Name:JOLLY, TARANJEET SINGH (MD)
Entity Type:Individual
Prefix:DR
First Name:TARANJEET
Middle Name:SINGH
Last Name:JOLLY
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 1:100 WALTER WARD BLVD
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:MD
Mailing Address - Zip Code:21009-1284
Mailing Address - Country:US
Mailing Address - Phone:410-777-8971
Mailing Address - Fax:
Practice Address - Street 1:100 WALTER WARD BLVD
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:MD
Practice Address - Zip Code:21009-1284
Practice Address - Country:US
Practice Address - Phone:410-777-8971
Practice Address - Fax:877-595-7180
Is Sole Proprietor?:No
Enumeration Date:2011-08-17
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4553932084P0800X, 2084P0804X
MDD00808992084P2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1032663500002Medicaid