Healthcare Provider Details

I. General information

NPI: 1437195682
Provider Name (Legal Business Name): JAGDEEP SINGH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5070 WINESAP WAY
ELLICOTT CITY MD
21043-7184
US

IV. Provider business mailing address

5070 WINESAP WAY
ELLICOTT CITY MD
21043-7184
US

V. Phone/Fax

Practice location:
  • Phone: 520-431-9777
  • Fax: 410-988-2633
Mailing address:
  • Phone: 520-431-9777
  • Fax: 410-988-2633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35962
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number219037
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0069796
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: