Healthcare Provider Details

I. General information

NPI: 1023515632
Provider Name (Legal Business Name): VIVEK MUKHERJEE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2018
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 CHURCH ST STE 14 #4667
WINCHESTER MA
01890
US

IV. Provider business mailing address

28 CHURCH ST STE 14
WINCHESTER MA
01890-2538
US

V. Phone/Fax

Practice location:
  • Phone: 312-635-0973
  • Fax: 312-635-0050
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number0101277084
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberMCS011463A
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: