Healthcare Provider Details

I. General information

NPI: 1114985686
Provider Name (Legal Business Name): JASVINDER PAL SINGH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 06/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1507 N ROAD ST SUITE 1
ELIZABETH CITY NC
27909-3243
US

IV. Provider business mailing address

1507 N ROAD ST SUITE 1
ELIZABETH CITY NC
27909-3243
US

V. Phone/Fax

Practice location:
  • Phone: 252-338-6167
  • Fax: 252-334-1755
Mailing address:
  • Phone: 252-338-6167
  • Fax: 252-334-1755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number33893
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number33893
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number33893
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number33893
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number33893
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: