Provider Demographics
NPI:1184672891
Name:CHALASANI, NAGESWARARAO VENKATA (MD)
Entity Type:Individual
Prefix:
First Name:NAGESWARARAO
Middle Name:VENKATA
Last Name:CHALASANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 UNIVERSITY DR S RT 1707
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-6104
Mailing Address - Country:US
Mailing Address - Phone:701-234-1728
Mailing Address - Fax:701-234-1681
Practice Address - Street 1:1720 UNIVERSITY DR S RT 1707
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6104
Practice Address - Country:US
Practice Address - Phone:701-234-1728
Practice Address - Fax:701-234-1681
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND7512207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN53A50CHOtherMN BLUE SHIELD
ND014818OtherND BLUE SHIELD
MN104026000Medicaid
ND10221Medicaid
ND050050519OtherRR MEDICARE