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General NPI Number Information
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NPI Number | 1700397130
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Entity Type | Individual
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Provider Name | ANIL BARAN MUKHERJEE M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/12/2017
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Last Update Date | 10/12/2017
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Provider Practice Location Address
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Address Line | 21120 GEORGIA AVE
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City | BROOKEVILLE
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State | MD
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Zip | 20833-0136
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Country | US
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Telephone | 301-774-1510
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Fax | 301-402-6632
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Provider Business Mailing Address
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Address Line | PO BOX 136
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City | BROOKEVILLE
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State | MD
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Zip | 20833-0136
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Country | US
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Telephone | 301-774-1510
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Fax | 301-402-6632
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | D0019139
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License Number State | MD
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