Healthcare Provider Details

I. General information

NPI: 1225329873
Provider Name (Legal Business Name): ALVIN PRINCE BANNERJEE D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2011
Last Update Date: 04/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 19TH ST NW STE 605
WASHINGTON DC
20036-3731
US

IV. Provider business mailing address

1600 E GUDE DR STE 200
ROCKVILLE MD
20850-1496
US

V. Phone/Fax

Practice location:
  • Phone: 202-833-9109
  • Fax:
Mailing address:
  • Phone: 301-933-7133
  • Fax: 301-933-7137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number01549
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: