Waterford Medical LTD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

036056086 Issued in IL

Legal business name

WATERFORD MEDICAL LTD

Practice address

5958 W Lawrence Ave
Chicago, IL 60630-3130

Phone

(773) 282-4572

Fax

(630) 820-6730

NPI assigned

Jul 2, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Sanjoy Majumdar, M.D.

Title

President

Phone

(630) 820-6730

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1183334400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1291939200000",
    "number": "1194922245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5958 W LAWRENCE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606303130",
            "telephone_number": "773-282-4572",
            "fax_number": "630-820-6730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5958 W LAWRENCE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606303130",
            "telephone_number": "773-282-4572",
            "fax_number": "630-820-6730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATERFORD MEDICAL LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-02",
        "last_updated": "2010-12-10",
        "status": "A",
        "authorized_official_last_name": "MAJUMDAR",
        "authorized_official_first_name": "SANJOY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "630-820-6730",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036056086",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.