Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 248454 | MA |
N | 111NI0900X | Internist | 248454 | MA |
Y | 207RC0000X | Internist - Cardiovascular Disease | 302416 | NY |
NPI | 1003103367 |
---|---|
Provider Name | Dr. Dahlia Banerji |
First Address | Worcester, MA 01608-1216 |
Second Address | Middletown, NY 10940-2115 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2011 |
Last Update Date | 11/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
302416 | NYS LICENSE (01) | NY |