Provider Demographics
NPI:1023120250
Name:MUKHERJEE, JAYANTA (MD)
Entity type:Individual
Prefix:
First Name:JAYANTA
Middle Name:
Last Name:MUKHERJEE
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 7527
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-0727
Mailing Address - Country:US
Mailing Address - Phone:614-544-6356
Mailing Address - Fax:
Practice Address - Street 1:3705 OLENTANGY RIVER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3467
Practice Address - Country:US
Practice Address - Phone:614-262-6772
Practice Address - Fax:614-447-2752
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35125188207R00000X, 207RC0000X
PAMD427613207R00000X
NC2012-01161207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2650171Medicaid
NC5922077Medicaid
SCNC1745Medicaid
OHH398930Medicare PIN
SCNC1745Medicaid