Basic Information
| Provider Information | |||||||||
| NPI: | 1629044854 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BANERJEE | ||||||||
| FirstName: | DEB | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3115 S PRICE RD | ||||||||
| Address2: | |||||||||
| City: | CHANDLER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852483544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8884887640 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3115 S PRICE RD | ||||||||
| Address2: | |||||||||
| City: | CHANDLER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852483544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4809260170 | ||||||||
| FaxNumber: | 4804520715 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2006 | ||||||||
| LastUpdateDate: | 06/20/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 29717 | AZ | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 29717 | AZ | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 110247811 | 01 | AZ | RAIL ROAD MEDICARE ID | OTHER | 61642703 | 05 | AZ | MEDICAID |