Provider Demographics
NPI:1609254754
Name:BANERJEE, SOHAM (MD (JUNE 2015))
Entity Type:Individual
Prefix:
First Name:SOHAM
Middle Name:
Last Name:BANERJEE
Suffix:
Gender:M
Credentials:MD (JUNE 2015)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BAYLOR PLZ
Mailing Address - Street 2:BCM 620
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-3411
Mailing Address - Country:US
Mailing Address - Phone:713-798-5588
Mailing Address - Fax:713-798-0223
Practice Address - Street 1:1 BAYLOR PLZ
Practice Address - Street 2:BCM 620
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3411
Practice Address - Country:US
Practice Address - Phone:713-798-5588
Practice Address - Fax:713-798-0223
Is Sole Proprietor?:No
Enumeration Date:2015-05-08
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXBP10052883207R00000X
TXT12962085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine