MEDICARE: MONICA MONIDIPA BANERJEE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician	32404	AZ
2	207R00000X	Internal Medicine Physician	32404	AZ

General Provider Information

NPI Number	:	1093782625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONICA MONIDIPA BANERJEE MD

Provider Business Mailing Address
First Line	:	PO BOX 7764
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85246-7764
Country	:	US
Telephone Number	:	480-291-4142
Fax Number	:	480-478-0647

Provider Business Practice Location Address
First Line	:	501 W RAY RD
Second Line	:	SUITE 6
City	:	CHANDLER
State	:	AZ
Zip	:	85225-7284
Country	:	US
Telephone Number	:	602-492-3565
Fax Number	:	602-492-3565

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2006
Last Update Date	:	03/05/2017

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