Provider Demographics
NPI:1740254895
Name:CHATTERJEE, LOLITA (MD)
Entity type:Individual
Prefix:
First Name:LOLITA
Middle Name:
Last Name:CHATTERJEE
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:PO BOX 95000-2454
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-2454
Mailing Address - Country:US
Mailing Address - Phone:212-252-6005
Mailing Address - Fax:
Practice Address - Street 1:55 EAST 34 STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016
Practice Address - Country:US
Practice Address - Phone:212-252-6005
Practice Address - Fax:212-252-6179
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204077207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01850004Medicaid
NY01850004Medicaid
G39386Medicare UPIN