Basic Information
Provider Information
NPI: 1861669681
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MUKERJEE
FirstName: ROMITA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3031 NEW BERN AVE
Address2: STE 306
City: RALEIGH
State: NC
PostalCode: 276102989
CountryCode: US
TelephoneNumber: 9194598409
FaxNumber: 9192313912
Practice Location
Address1: 790 SE CARY PKWY STE 101
Address2:  
City: CARY
State: NC
PostalCode: 275115678
CountryCode: US
TelephoneNumber: 9192350644
FaxNumber: 9193808285
Other Information
ProviderEnumerationDate: 05/12/2008
LastUpdateDate: 04/28/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/28/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RN0300X201201162NCY Allopathic & Osteopathic PhysiciansInternal MedicineNephrology

No ID Information.


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