Healthcare Provider Details

I. General information

NPI: 1902130156
Provider Name (Legal Business Name): NORTH TEXAS RHEUMATOLOGY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2009
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8220 WALNUT HILL LN STE 414
DALLAS TX
75231-4417
US

IV. Provider business mailing address

8220 WALNUT HILL LN STE 414
DALLAS TX
75231-4417
US

V. Phone/Fax

Practice location:
  • Phone: 469-916-0677
  • Fax:
Mailing address:
  • Phone: 469-916-0677
  • Fax: 214-716-5283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberM2255
License Number StateTX

VIII. Authorized Official

Name: DR. POOJA BANERJEE
Title or Position: OWNER / DIRECTOR / PHYSICIAN
Credential: MD
Phone: 469-916-0677