Provider Demographics
NPI:1205910106
Name:CHATTERJEE, MINAKSHI (M D)
Entity type:Individual
Prefix:DR
First Name:MINAKSHI
Middle Name:
Last Name:CHATTERJEE
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 LOCUST ST
Mailing Address - Street 2:APT 4A
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-3935
Mailing Address - Country:US
Mailing Address - Phone:215-831-2800
Mailing Address - Fax:
Practice Address - Street 1:220 LOCUST ST
Practice Address - Street 2:APT 4A
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-3935
Practice Address - Country:US
Practice Address - Phone:215-831-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044609E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012399220003Medicaid
PAE84744Medicare UPIN
PA0012399220003Medicaid