Provider Demographics
NPI:1558340265
Name:MUKHERJEE, SHANKER (MD)
Entity Type:Individual
Prefix:DR
First Name:SHANKER
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 1:20 COMMUNITY DR
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-2658
Mailing Address - Country:US
Mailing Address - Phone:610-258-6635
Mailing Address - Fax:610-258-2879
Practice Address - Street 1:20 COMMUNITY DR
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-2658
Practice Address - Country:US
Practice Address - Phone:610-258-6635
Practice Address - Fax:610-258-2879
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05151400174400000X
PAMD043637E174400000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001176706Medicaid
PA130971OtherMEDPLUS PROVIDER #
PAP2540329OtherOXFORD PROVIDER #
PA20008608OtherAMERIHEALTH MERCY PROV #
PA5555683OtherCIGNA PROVIDER #
PA723788OtherHIGHMARK BS PROVIDER #
NJ1190008Medicaid
PA01075001OtherCAPITAL BC PROVIDER #
NJ1190008Medicaid