Provider Demographics
NPI:1053418509
Name:JAGADEESAN, SINGARAVELU (MD)
Entity type:Individual
Prefix:DR
First Name:SINGARAVELU
Middle Name:
Last Name:JAGADEESAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 936857
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-6857
Mailing Address - Country:US
Mailing Address - Phone:910-662-7500
Mailing Address - Fax:910-662-7501
Practice Address - Street 1:1509 DOCTORS CIR BLDG C
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7403
Practice Address - Country:US
Practice Address - Phone:910-662-7500
Practice Address - Fax:910-662-7501
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2004002172084N0400X
WAMD605885792084N0400X
FLME1689072084N0400X
173F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No173F00000XOther Service ProvidersSleep Specialist, PhD
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1053418509Medicaid
NC5903406Medicaid
SCNC2736Medicaid
SCNC2736Medicaid
NC2025403BMedicare PIN
NC1053418509Medicaid
NCNC0346DMedicare PIN