=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437143260
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SATYABRATA CHATTERJEE MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/08/2005
-----------------------------------------------------
Last Update Date | 03/21/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12205 COUNTY LINE RD STE D
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35758-7720
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 938-227-6307
-----------------------------------------------------
Fax | 938-227-6318
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 73 THOMPSON POYNTER RD STE D
-----------------------------------------------------
City | LONDON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40741-7202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-877-1849
-----------------------------------------------------
Fax | 606-877-1850
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | 22780
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------