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General NPI Number Information
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NPI Number | 1053418509
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Entity Type | Individual
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Provider Name | SINGARAVELU JAGADEESAN MD
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Gender | Male
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Dates
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Enumeration Date | 09/19/2006
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Last Update Date | 05/21/2025
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Provider Practice Location Address
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Address Line | 815 COX RD
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City | GASTONIA
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State | NC
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Zip | 28054-3453
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Country | US
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Telephone | 704-865-1700
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Fax | 704-865-7948
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Provider Business Mailing Address
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Address Line | PO BOX 744786
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City | ATLANTA
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State | GA
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Zip | 30374-4786
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Country | US
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Telephone | 704-834-2450
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Fax | 704-671-5331
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173F00000X
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Taxonomy Name | Sleep Specialist (PhD)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | MD60588579
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 0450820
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License Number State | KS
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Taxonomy #4
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | ME168907
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 200400217
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License Number State | NC
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