Provider Demographics
NPI:1063495562
Name:BANERJI, ALEENA (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEENA
Middle Name:
Last Name:BANERJI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-726-3850
Mailing Address - Fax:617-724-0239
Practice Address - Street 1:100 BLOSSOM STREET
Practice Address - Street 2:COX 201
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-3117
Practice Address - Country:US
Practice Address - Phone:617-726-3850
Practice Address - Fax:617-724-0239
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA214055207R00000X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0174301Medicaid
MAJ25223OtherBCBS MA
MA214055OtherTUFTS HEALTH PLAN
MAJ25223OtherBCBS MA
MAA34390Medicare PIN