Provider Demographics
NPI:1568728921
Name:MANISHI G MUKHERJEE MD PA
Entity Type:Organization
Organization Name:MANISHI G MUKHERJEE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MANISHI
Authorized Official - Middle Name:G
Authorized Official - Last Name:MUKHERJEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:727-526-9899
Mailing Address - Street 1:5880 49TH ST N STE 206
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-2147
Mailing Address - Country:US
Mailing Address - Phone:727-526-9899
Mailing Address - Fax:727-525-0923
Practice Address - Street 1:5880 49TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-2150
Practice Address - Country:US
Practice Address - Phone:727-526-9899
Practice Address - Fax:727-525-9023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME27749207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D85976Medicare UPIN
52924Medicare PIN