Provider Demographics
NPI:1801847983
Name:MUKHERJEE, DIPANKAR (MD)
Entity type:Individual
Prefix:
First Name:DIPANKAR
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 1:174 LOWELL ROAD
Mailing Address - Street 2:UNIT 135
Mailing Address - City:MASHPEE
Mailing Address - State:MA
Mailing Address - Zip Code:02649-2858
Mailing Address - Country:US
Mailing Address - Phone:508-477-3142
Mailing Address - Fax:508-477-3142
Practice Address - Street 1:174 LOWELL ROAD
Practice Address - Street 2:UNIT 135
Practice Address - City:MASHPEE
Practice Address - State:MA
Practice Address - Zip Code:02649-2858
Practice Address - Country:US
Practice Address - Phone:508-477-3142
Practice Address - Fax:508-477-3142
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA54178207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA438895OtherHPHC
MAH10147OtherBCBS
B87243Medicare UPIN
H10147Medicare ID - Type Unspecified