Provider Demographics
NPI:1730144189
Name:BANERJEE, TIMIR (MD)
Entity Type:Individual
Prefix:
First Name:TIMIR
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:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:220 ABRAHAM FLEXNER WAY STE 1200
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202
Practice Address - Country:US
Practice Address - Phone:502-899-3623
Practice Address - Fax:502-899-7970
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20052207T00000X
IN01028862A208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000381968OtherANTHEM-NICC
KY64200520Medicaid
INP00362319OtherRAILROAD MEDICARE
KYP00362322OtherRAILROAD MEDICARE
IN100006949Medicaid
KY035861OtherSIHO / NICC
KY035861OtherSIHO / NICC
IN100006949Medicaid