1083690143 NPI number — ANTHONY & BANERJEE MD PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083690143 NPI number — ANTHONY & BANERJEE MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANTHONY & BANERJEE MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1083690143
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/16/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
827 LINDEN AVE
Provider Second Line Business Mailing Address:
STE 3E-F
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21201-4606
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-225-8404
Provider Business Mailing Address Fax Number:
410-225-8062

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
827 LINDEN AVE
Provider Second Line Business Practice Location Address:
STE 3E-F
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21201-4606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-225-8404
Provider Business Practice Location Address Fax Number:
410-225-8062
Provider Enumeration Date:
12/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ANTHONY
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
CHARLES
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
410-225-8514

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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