Provider Demographics
NPI:1730121575
Name:BANERJEE, SANJOY (MD)
Entity Type:Individual
Prefix:
First Name:SANJOY
Middle Name:
Last Name:BANERJEE
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 1:2109 HUGHES DR
Mailing Address - Street 2:SUITE 860
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-3856
Mailing Address - Country:US
Mailing Address - Phone:419-291-7010
Mailing Address - Fax:419-479-6917
Practice Address - Street 1:2109 HUGHES DR
Practice Address - Street 2:SUITE 860
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3856
Practice Address - Country:US
Practice Address - Phone:419-291-7010
Practice Address - Fax:419-479-6917
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0878382080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000521494OtherANTHEM
MI5202134Medicaid
OH7978181OtherAETNA
OH06120OtherPARAMOUNT
OH2665692OtherBCMH
$$$$$$$$$OtherMMO
OH2665692Medicaid
OH734534OtherBUCKEYE COMMUNITY HEALTH
46880OtherHEALTH PLAN OF MI
OH2665692Medicaid
MI5202134Medicaid
OHBA4183831Medicare PIN