Healthcare Provider Details

I. General information

NPI: 1780630947
Provider Name (Legal Business Name): MADHU P CHALASANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 02/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8050 BECKETT CENTER DR STE 108
WEST CHESTER OH
45069-5024
US

IV. Provider business mailing address

8050 BECKETT CENTER DR STE 108
WEST CHESTER OH
45069-5024
US

V. Phone/Fax

Practice location:
  • Phone: 513-618-7430
  • Fax: 513-280-8868
Mailing address:
  • Phone: 513-618-7430
  • Fax: 513-280-8868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number35-079504
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35-079504
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: