Provider Demographics
NPI:1154670180
Name:BACSU, CHASTA-DAWNE LOUISE (MD)
Entity Type:Individual
Prefix:
First Name:CHASTA-DAWNE
Middle Name:LOUISE
Last Name:BACSU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5323 HARRY HINES BLVD
Mailing Address - Street 2:UROL. DEPARTMENT, J08.122, MOSS CLINICAL SCIENCE BLDG
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390-9110
Mailing Address - Country:US
Mailing Address - Phone:214-648-7191
Mailing Address - Fax:214-648-8786
Practice Address - Street 1:5323 HARRY HINES BLVD
Practice Address - Street 2:UROL. DEPARTMENT, J08.122, MOSS CLINICAL SCIENCE BLDG
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-9110
Practice Address - Country:US
Practice Address - Phone:214-648-7191
Practice Address - Fax:214-648-8786
Is Sole Proprietor?:No
Enumeration Date:2012-09-06
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10045080390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program