Provider Demographics
NPI:1376630970
Name:MUKERJEE, ADHIP (MD)
Entity Type:Individual
Prefix:
First Name:ADHIP
Middle Name:
Last Name:MUKERJEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 ALDEN RD
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-3719
Mailing Address - Country:US
Mailing Address - Phone:978-287-3700
Mailing Address - Fax:978-287-3729
Practice Address - Street 1:133 OLD ROAD TO 9 ACRE COR
Practice Address - Street 2:RADIOLOGY DEPARTMENT EMERSON HOSPITAL
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-4159
Practice Address - Country:US
Practice Address - Phone:978-287-3700
Practice Address - Fax:978-287-3729
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA573312085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3066703Medicaid
MAJ10099Medicare ID - Type UnspecifiedMEDICARE
MA3066703Medicaid