MEDICARE: DR. SANGEETA BANERJEE M.D.

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	2084P0800X	Psychiatry Physician	223258	MA

General Provider Information

NPI Number	:	1285605907
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANGEETA BANERJEE M.D.

Provider Business Mailing Address
First Line	:	12 ALFRED ST
Second Line	:	SUITE 200
City	:	WOBURN
State	:	MA
Zip	:	01801-1915
Country	:	US
Telephone Number	:	781-646-0500
Fax Number	:	781-646-7130

Provider Business Practice Location Address
First Line	:	92 MONTVALE AVE
Second Line	:	SUITE 2450
City	:	STONEHAM
State	:	MA
Zip	:	02180-3647
Country	:	US
Telephone Number	:	781-646-0500
Fax Number	:	781-646-7130

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

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	09/07/2007

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