Provider Demographics
NPI:1629342613
Name:MUKHERJEE, AMRITA (DO)
Entity type:Individual
Prefix:DR
First Name:AMRITA
Middle Name:
Last Name:MUKHERJEE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15245 SHADY GROVE RD STE 340
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-7201
Mailing Address - Country:US
Mailing Address - Phone:667-303-1042
Mailing Address - Fax:301-417-4947
Practice Address - Street 1:18550 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY VILLAGE
Practice Address - State:MD
Practice Address - Zip Code:20886-0586
Practice Address - Country:US
Practice Address - Phone:301-869-9776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-08
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0098902207Q00000X, 208D00000X, 208D00000X
FLOS11594208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH0098902OtherMARYLAND DEPARTMENT OF HEALTH
MD192425700Medicaid
MD192425700Medicaid