Basic Information
| Provider Information | |||||||||
| NPI: | 1457461105 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SINGH | ||||||||
| FirstName: | RAJEEV | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 16 BRENTSHIRE SQ | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383052203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7316640994 | ||||||||
| FaxNumber: | 7316640866 | ||||||||
| Practice Location | |||||||||
| Address1: | 1999 HIGHWAY 51 S | ||||||||
| Address2: | |||||||||
| City: | COVINGTON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 380193630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9014764457 | ||||||||
| FaxNumber: | 9014754389 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 03/07/2017 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 41497 | TN | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207P00000X | MD41497 | TN | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 4355442 | 01 | TN | CIGNA | OTHER | 4134914 | 01 | TN | BLUE CROSS BLUE SHIELD | OTHER | 626001636 | 01 | TN | BAPTISIT HEALTH SERVICE G | OTHER | 10026976 | 01 | TN | UAHC | OTHER | 3822078 | 05 | TN | MEDICAID | 38135 | 01 | TN | TLC | OTHER | 626001636 | 01 | USA MANAGED CARE | OTHER |