Healthcare Provider Details

I. General information

NPI: 1114902210
Provider Name (Legal Business Name): CHANDRALEKHA BANERJEE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2005
Last Update Date: 11/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

827 LINDEN AVE SUITE 3E-F
BALTIMORE MD
21201-4606
US

IV. Provider business mailing address

827 LINDEN AVE SUITE 3E-F
BALTIMORE MD
21201-4606
US

V. Phone/Fax

Practice location:
  • Phone: 410-225-8404
  • Fax: 410-225-8062
Mailing address:
  • Phone: 410-225-8404
  • Fax: 410-225-8062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberD34839
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: