Provider Demographics
NPI:1114902210
Name:BANERJEE, CHANDRALEKHA (MD)
Entity Type:Individual
Prefix:
First Name:CHANDRALEKHA
Middle Name:
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 1:827 LINDEN AVE
Mailing Address - Street 2:SUITE 3E-F
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-4606
Mailing Address - Country:US
Mailing Address - Phone:410-225-8404
Mailing Address - Fax:410-225-8062
Practice Address - Street 1:827 LINDEN AVE
Practice Address - Street 2:SUITE 3E-F
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-4606
Practice Address - Country:US
Practice Address - Phone:410-225-8404
Practice Address - Fax:410-225-8062
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-12
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD34839207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD096401800Medicaid
E57441Medicare UPIN
MD096401800Medicaid