Healthcare Provider Details

I. General information

NPI: 1821786203
Provider Name (Legal Business Name): SIMARDEEP SINGH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2023
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date: 11/29/2023
Reactivation Date: 12/05/2023

III. Provider practice location address

2800 GODWIN BLVD
SUFFOLK VA
23434-8038
US

IV. Provider business mailing address

2800 GODWIN BLVD
SUFFOLK VA
23434-8038
US

V. Phone/Fax

Practice location:
  • Phone: 757-934-4000
  • Fax:
Mailing address:
  • Phone: 757-934-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101289235
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: