Healthcare Provider Details

I. General information

NPI: 1770154262
Provider Name (Legal Business Name): GARIMA CHOPRA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2021
Last Update Date: 07/05/2024
Certification Date: 07/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WUSM PEDS, 1 CHILDRENS PL MSC 8116-0043-08
SAINT LOUIS MO
63110
US

IV. Provider business mailing address

WUSM PEDS, 1 CHILDRENS PL MSC 8116-0043-08
SAINT LOUIS MO
63110
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-4826
  • Fax: 314-454-4633
Mailing address:
  • Phone: 314-454-4826
  • Fax: 314-454-4633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2024012647
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number2021016219
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2024025985
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: