Provider Demographics
NPI:1437143260
Name:CHATTERJEE, SATYABRATA (MD)
Entity Type:Individual
Prefix:
First Name:SATYABRATA
Middle Name:
Last Name:CHATTERJEE
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 1:73 THOMPSON POYNTER RD STE D
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-7202
Mailing Address - Country:US
Mailing Address - Phone:606-877-1849
Mailing Address - Fax:606-877-1850
Practice Address - Street 1:12205 COUNTY LINE RD STE D
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-7720
Practice Address - Country:US
Practice Address - Phone:938-227-6307
Practice Address - Fax:938-227-6318
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY22780207RC0000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64227804Medicaid
KY000000639622OtherBCBS- SJL, PMS DBA PREMIER HEART & VASCULAR CENTERS
KY64227804Medicaid
KY0120704Medicare PIN
KY000000584946OtherBCBS -CUMBERLAND CLINIC
KY00190004Medicare PIN