Provider Demographics
NPI:1528053147
Name:CHATTERJI, SANJIV (MD PHD)
Entity type:Individual
Prefix:DR
First Name:SANJIV
Middle Name:
Last Name:CHATTERJI
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2016 STONEGATE TRL
Mailing Address - Street 2:SUITE 112
Mailing Address - City:VESTAVIA HILLS
Mailing Address - State:AL
Mailing Address - Zip Code:35242-2260
Mailing Address - Country:US
Mailing Address - Phone:205-545-9530
Mailing Address - Fax:205-545-9529
Practice Address - Street 1:50 MEDICAL PARK DR E
Practice Address - Street 2:ST. VINCENT'S EAST
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-3401
Practice Address - Country:US
Practice Address - Phone:205-545-9530
Practice Address - Fax:205-545-9529
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00020559207P00000X
AL20559207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529910000Medicaid
AL009933407Medicaid
AL351890800OtherDEPT OF LABOR
ALCH5239OtherRR MEDICARE
AL051521132OtherBCBS
AL51531676OtherBCBS
AL051554533Medicaid
AL529905830Medicaid
ALC141OtherBCBS
ALC141OtherBCBS
051556986CHAMedicare ID - Type Unspecified
AL529910000Medicaid
ALI756Medicare PIN