1154334936 NPI number — DR. PRASHANT K MUKERJEE M.D.

Table of content: DR. PRASHANT K MUKERJEE M.D. (NPI 1154334936)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154334936 NPI number — DR. PRASHANT K MUKERJEE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MUKERJEE
Provider First Name:
PRASHANT
Provider Middle Name:
K
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154334936
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/19/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27890 CLINTON KEITH RD STE 2
Provider Second Line Business Mailing Address:
MAIL BOX 380
Provider Business Mailing Address City Name:
MURRIETA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92562-8571
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-973-8130
Provider Business Mailing Address Fax Number:
951-808-0957

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
35673 COUNTRY PARK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILDOMAR
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92595-7840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-973-8130
Provider Business Practice Location Address Fax Number:
951-808-0957
Provider Enumeration Date:
08/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X , with the licence number:  C54408 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RP1001X , with the licence number: MD016833E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0061650000 . This is a "INDEPENDENCE BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: E55499 . This is a "SENIORPARTNERS HEALTHPART" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0059907407 . This is a "AMERICHOICE M/C & M.A." identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 159440 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 31903A . This is a "KEYSTONE MERCY HEALTH PLN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: DES140 . This is a "OXFORD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0005990740002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2Y5985 . This is a "ELDERHEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 159440 . This is a "AETNA U.S. HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 159440 . This is a "CIGNA INSURANCE COMPANY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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