Provider Demographics
NPI:1740283027
Name:MUKHERJEE, RATNAKAR (MD)
Entity type:Individual
Prefix:DR
First Name:RATNAKAR
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 1:7845 OAKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-4280
Mailing Address - Country:US
Mailing Address - Phone:410-768-0919
Mailing Address - Fax:410-760-5932
Practice Address - Street 1:7845 OAKWOOD RD
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-4280
Practice Address - Country:US
Practice Address - Phone:410-768-0919
Practice Address - Fax:410-760-5932
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229947207R00000X, 207RC0000X, 208M00000X
MA227473207RI0011X
MDD0065911207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD412694700Medicaid
MDKK38Q947Medicare PIN
MDP00778770Medicare PIN
MDP00458788Medicare PIN
I12775Medicare UPIN
MD034MQ943Medicare PIN