Healthcare Provider Details

I. General information

NPI: 1487664306
Provider Name (Legal Business Name): CHALASANI MD INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 01/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 GREENVILLE RD.
ST. MARYS OH
45885
US

IV. Provider business mailing address

PO BOX 719 1300 GREENVILLE RD.
ST. MARYS OH
45885
US

V. Phone/Fax

Practice location:
  • Phone: 419-394-4813
  • Fax: 419-394-1546
Mailing address:
  • Phone: 419-394-4813
  • Fax: 419-394-1546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PADMAJA CHALASANI
Title or Position: MD/OWNER
Credential: MD
Phone: 419-394-4813