Provider Demographics
NPI:1770761595
Name:BANERJEE, SUMAN KUMAR (MD)
Entity type:Individual
Prefix:DR
First Name:SUMAN
Middle Name:KUMAR
Last Name:BANERJEE
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 1:11816 OLDE COVINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-5699
Mailing Address - Country:US
Mailing Address - Phone:804-364-2095
Mailing Address - Fax:
Practice Address - Street 1:11816 OLDE COVINGTON WAY
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-5699
Practice Address - Country:US
Practice Address - Phone:804-364-2095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-04
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101239875207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology