Provider Demographics
NPI:1972567675
Name:BANERJI, CHINMAYEE (MD)
Entity type:Individual
Prefix:
First Name:CHINMAYEE
Middle Name:
Last Name:BANERJI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHINMAYEE
Other - Middle Name:
Other - Last Name:DEBNATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4700 MILLENIA BLVD STE 650
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32839-6013
Mailing Address - Country:US
Mailing Address - Phone:407-447-7120
Mailing Address - Fax:
Practice Address - Street 1:1118 W MERCURY BLVD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-3328
Practice Address - Country:US
Practice Address - Phone:757-276-9526
Practice Address - Fax:877-487-2116
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101053502207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010225965Medicaid
VA009356M49Medicare PIN
VA009824M55Medicare PIN
VA010225965Medicaid