Provider Demographics
NPI:1851731830
Name:MOOKERJEE, SUSMITA (MD)
Entity type:Individual
Prefix:DR
First Name:SUSMITA
Middle Name:
Last Name:MOOKERJEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13719 LORAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-3439
Mailing Address - Country:US
Mailing Address - Phone:216-307-3005
Mailing Address - Fax:216-710-5360
Practice Address - Street 1:13719 LORAIN AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-3439
Practice Address - Country:US
Practice Address - Phone:216-307-3005
Practice Address - Fax:216-710-5360
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-05
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.129168208M00000X, 207R00000X
MI4301103990207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0181522Medicaid