Provider Demographics
NPI:1437117579
Name:BANERJEE, DEEPAK D (MD)
Entity Type:Individual
Prefix:
First Name:DEEPAK
Middle Name:D
Last Name:BANERJEE
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 1:435 E COMMONWEATH BLVD
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112
Mailing Address - Country:US
Mailing Address - Phone:276-403-4278
Mailing Address - Fax:276-403-4278
Practice Address - Street 1:435 COMMONWEALTH BLVD E
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-2014
Practice Address - Country:US
Practice Address - Phone:276-403-4278
Practice Address - Fax:276-403-4283
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101230554207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1437117579Medicaid
VA1437117579Medicaid
VA015945R53Medicare PIN
VAP00670724Medicare PIN