Basic Information
| Provider Information | |||||||||
| NPI: | 1386901353 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAJUMDER | ||||||||
| FirstName: | PRATYAYA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 E BROAD ST | ||||||||
| Address2: | P.O. BOX 980050 | ||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232985058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8048289071 | ||||||||
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| Practice Location | |||||||||
| Address1: | 800 BIESTERFIELD RD STE 510 | ||||||||
| Address2: | |||||||||
| City: | ELK GROVE VILLAGE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600073367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8479813660 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2012 | ||||||||
| LastUpdateDate: | 04/05/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 0116028981 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 036137400 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RP1001X | 036137400 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 036137400 | 05 | IL | MEDICAID |