Healthcare Provider Details

I. General information

NPI: 1609987684
Provider Name (Legal Business Name): PREM SINGH SHEKHAWAT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 MOYE BLVD ECU PHYSICIANS NEONATAL CHILDREN'S HOSPITAL 227
GREENVILLE NC
27834-4300
US

IV. Provider business mailing address

2500 METROHEALTH DR DEPT OF
CLEVELAND OH
44109-1900
US

V. Phone/Fax

Practice location:
  • Phone: 252-744-0766
  • Fax: 252-744-0392
Mailing address:
  • Phone: 216-778-8106
  • Fax: 216-778-3252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number2011-01666
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number050059
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number35.091498
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: