Provider Demographics
NPI:1356371744
Name:MUKHERJEE, DEBMALYA (MD)
Entity type:Individual
Prefix:DR
First Name:DEBMALYA
Middle Name:
Last Name:MUKHERJEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:DEB
Other - Middle Name:
Other - Last Name:MUKHERJEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, MBA
Mailing Address - Street 1:2842 MAIN ST STE 305
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-1077
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:75 STATE ST FL 26
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02109-1827
Practice Address - Country:US
Practice Address - Phone:855-347-4108
Practice Address - Fax:616-830-8213
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT044815207R00000X, 208M00000X
MA233803207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001448150Medicaid
CT1356371744OtherCIGNA
MA134550OtherFALLON
MA510492088OtherUHC
MAAA113569OtherHPHC
9585080OtherAETNA
CT0000439OtherTRICARE
CT010044815CTD1OtherBCBS
MA510492088OtherCIGNA
MAJ42785OtherBCBS
MA2148480Medicaid
44815OtherCONNECTICARE
CT0000439OtherTRICARE
CT1356371744OtherCIGNA
MA134550OtherFALLON