Healthcare Provider Details

I. General information

NPI: 1972741551
Provider Name (Legal Business Name): SUJATA CHATTERJI BUCK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUJATA AIYER M.D.

II. Dates (important events)

Enumeration Date: 02/04/2009
Last Update Date: 02/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 WEST PINE COURT
SAINT LOUIS MO
63108-2110
US

IV. Provider business mailing address

4 WEST PINE COURT
SAINT LOUIS MO
63108-2110
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-3831
  • Fax:
Mailing address:
  • Phone: 314-454-3831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2006027158
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101036604
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number2006027158
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number0101036604
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: