Provider Demographics
NPI:1336554591
Name:KHAIRA, JAGROOP SINGH
Entity Type:Individual
Prefix:
First Name:JAGROOP
Middle Name:SINGH
Last Name:KHAIRA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 HOSPITAL DRIVE, 5TH FLOOR
Mailing Address - Street 2:PRINCE GEORGE'S HOSPITAL CENTER(DEPARTMENT OF MEDICINE)
Mailing Address - City:CHEVERLY
Mailing Address - State:MD
Mailing Address - Zip Code:20785
Mailing Address - Country:US
Mailing Address - Phone:301-618-3776
Mailing Address - Fax:301-618-2986
Practice Address - Street 1:3001 HOSPITAL DRIVE, 5TH FLOOR
Practice Address - Street 2:PRINCE GEORGE'S HOSPITAL CENTER(DEPARTMENT OF MEDICINE)
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785
Practice Address - Country:US
Practice Address - Phone:301-618-3776
Practice Address - Fax:301-618-2986
Is Sole Proprietor?:No
Enumeration Date:2014-06-26
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60712876207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program