Provider Demographics
NPI:1215980602
Name:SANGHA, JASJEET SINGH (MD)
Entity type:Individual
Prefix:
First Name:JASJEET
Middle Name:SINGH
Last Name:SANGHA
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 2758
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50704-2758
Mailing Address - Country:US
Mailing Address - Phone:319-235-5390
Mailing Address - Fax:319-233-1630
Practice Address - Street 1:3530 WEST 4TH STREET
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-4503
Practice Address - Country:US
Practice Address - Phone:319-233-2701
Practice Address - Fax:319-236-7993
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21445207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2157966Medicaid
IA44468OtherWELLMARK INS PLAN
IA421417307B5OtherJOHN DEERE HEALTH INS PLA
A01373Medicare UPIN
IA421417307B5OtherJOHN DEERE HEALTH INS PLA