Provider Demographics
NPI:1417115205
Name:MUKHERJEE, AVIK (MD)
Entity Type:Individual
Prefix:DR
First Name:AVIK
Middle Name:
Last Name:MUKHERJEE
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 1:7900 SHRADER RD
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23294-4215
Mailing Address - Country:US
Mailing Address - Phone:804-288-1953
Mailing Address - Fax:804-288-1953
Practice Address - Street 1:7900 SHRADER RD
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23294-4215
Practice Address - Country:US
Practice Address - Phone:804-288-1953
Practice Address - Fax:804-288-1953
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101243025208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery