Provider Demographics
NPI:1790766459
Name:SINGH, INDERJEET (MD, FACS)
Entity Type:Individual
Prefix:
First Name:INDERJEET
Middle Name:
Last Name:SINGH
Suffix:
Gender:M
Credentials:MD, FACS
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 550790
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28055-0790
Mailing Address - Country:US
Mailing Address - Phone:704-864-6484
Mailing Address - Fax:704-864-6488
Practice Address - Street 1:2555 COURT DR
Practice Address - Street 2:SUITE 460
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2134
Practice Address - Country:US
Practice Address - Phone:704-864-6484
Practice Address - Fax:704-864-6488
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2010-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9801498208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1159UOtherBCBSNC
NC891159UMedicaid
NC2260437AMedicare ID - Type Unspecified
NCG85225Medicare UPIN