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General NPI Number Information
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NPI Number | 1174879795
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Entity Type | Individual
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Provider Name | ROBYN NATHAN BANERJEE MD
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Gender | Male
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Dates
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Enumeration Date | 08/01/2012
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Last Update Date | 08/01/2012
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Provider Practice Location Address
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Address Line | 200 MEDICAL PLZ B265
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City | LOS ANGELES
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State | CA
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Zip | 90095-0001
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Country | US
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Telephone | 310-206-2510
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Fax |
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Provider Business Mailing Address
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Address Line | 1041 GLENDON AVE 4187
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City | LOS ANGELES
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State | CA
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Zip | 90024-2913
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Country | US
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Telephone | 310-592-5228
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | A122036
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License Number State | CA
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