Debabrata Banerji, M.D.

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

R6523 Issued in MO

Practice address

83 Progress Pkwy
Maryland Heights, MO 63043

Phone

(314) 434-8174

Fax

(314) 434-8706

NPI assigned

Jul 8, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1120780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1321833600000",
    "number": "1548268014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "83 PROGRESS PKWY",
            "city": "MARYLAND HEIGHTS",
            "state": "MO",
            "postal_code": "630433701",
            "telephone_number": "314-434-8174",
            "fax_number": "314-434-8706"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "83 PROGRESS PKWY",
            "city": "MARYLAND HEIGHTS",
            "state": "MO",
            "postal_code": "63043",
            "telephone_number": "314-434-8174",
            "fax_number": "314-434-8706"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANERJI",
        "first_name": "DEBABRATA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-08",
        "last_updated": "2011-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "MO",
            "license": "R6523",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201187705",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• General Practice Physician in Maryland Heights, MO
• Providers in Maryland Heights, MO by specialty
• General Practice Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2011; 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.