1780789784 NPI number — DIPALI BANERJEE M.D.

Table of content: DIPALI BANERJEE M.D. (NPI 1780789784)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780789784 NPI number — DIPALI BANERJEE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BANERJEE
Provider First Name:
DIPALI
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1780789784
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/03/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2486
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46206-2486
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2875 W 19TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60623-3501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-665-3045
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/14/2006

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: 207ZP0102X , with the licence number:  036058352 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P00332720 . This is a "RAILROAD MEDICARE- PSIL" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 364125320002 . This is a "CHAMPUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01621061 . This is a "BCBS PATHOLOGY CHP" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036058352 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01636148 . This is a "BCBS PATHOLOGY SERVICE IL" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 220033246 . This is a "RAILROAD MEDICARE-PATHOLOGY CHP" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 132302200 . This is a "DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".




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