Healthcare Provider Details

I. General information

NPI: 1063495562
Provider Name (Legal Business Name): ALEENA BANERJI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 07/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BLOSSOM STREET COX 201
BOSTON MA
02114-3117
US

IV. Provider business mailing address

PO BOX 9142 MASS GENERAL PHYSICIAN ORGANIZATION
CHARLESTOWN MA
02129-9142
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-3850
  • Fax: 617-724-0239
Mailing address:
  • Phone: 617-726-3850
  • Fax: 617-724-0239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number214055
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number214055
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: