=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790740025
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR CHALASANI & ASSOC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2006
-----------------------------------------------------
Last Update Date | 07/22/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8542 SIEGEN LN
-----------------------------------------------------
City | BATON ROUGE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70810-1940
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-767-3278
-----------------------------------------------------
Fax | 225-767-3262
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8542 SIEGEN LN
-----------------------------------------------------
City | BATON ROUGE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70810-1940
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-767-3278
-----------------------------------------------------
Fax | 225-767-3262
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | ANNA DUPONT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 225-767-3278
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 015456
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------