Provider Demographics
NPI:1093782625
Name:BANERJEE, MONICA MONIDIPA (MD)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:MONIDIPA
Last Name:BANERJEE
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 7764
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85246-7764
Mailing Address - Country:US
Mailing Address - Phone:480-291-4142
Mailing Address - Fax:480-478-0647
Practice Address - Street 1:501 W RAY RD
Practice Address - Street 2:SUITE 6
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-7284
Practice Address - Country:US
Practice Address - Phone:602-492-3565
Practice Address - Fax:602-492-3565
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-02
Last Update Date:2017-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32404207RH0002X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F98328Medicare UPIN