Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 2012-01161 | NC |
N | 111NI0900X | Internist | 2012-01161 | NC |
N | 207R00000X | Internist | 35125188 | OH |
N | 111NI0900X | Internist | 35125188 | OH |
N | 207R00000X | Internist | MD427613 | PA |
N | 111NI0900X | Internist | MD427613 | PA |
Y | 207RC0000X | Internist - Cardiovascular Disease | 35125188 | OH |
NPI | 1023120250 |
---|---|
Provider Name | Jayanta Mukherjee |
First Address | Dublin, OH 43017-0727 |
Second Address | Columbus, OH 43214-3467 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2006 |
Last Update Date | 25/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2650171 | (05) | OH |
5922077 | (05) | NC |
NC1745 | (05) | SC |