Provider Demographics
NPI:1700397130
Name:MUKHERJEE, ANIL BARAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ANIL
Middle Name:BARAN
Last Name:MUKHERJEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 136
Mailing Address - Street 2:
Mailing Address - City:BROOKEVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20833-0136
Mailing Address - Country:US
Mailing Address - Phone:301-774-1510
Mailing Address - Fax:301-402-6632
Practice Address - Street 1:21120 GEORGIA AVE
Practice Address - Street 2:
Practice Address - City:BROOKEVILLE
Practice Address - State:MD
Practice Address - Zip Code:20833-0136
Practice Address - Country:US
Practice Address - Phone:301-774-1510
Practice Address - Fax:301-402-6632
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-12
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0019139207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine