Provider Demographics
NPI:1487664306
Name:CHALASANI MD INC.
Entity Type:Organization
Organization Name:CHALASANI MD INC.
Other - Org Name:ST. MARYS FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PADMAJA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHALASANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-394-4813
Mailing Address - Street 1:PO BOX 719
Mailing Address - Street 2:1300 GREENVILLE RD.
Mailing Address - City:ST. MARYS
Mailing Address - State:OH
Mailing Address - Zip Code:45885
Mailing Address - Country:US
Mailing Address - Phone:419-394-4813
Mailing Address - Fax:419-394-1546
Practice Address - Street 1:1300 GREENVILLE RD.
Practice Address - Street 2:
Practice Address - City:ST. MARYS
Practice Address - State:OH
Practice Address - Zip Code:45885
Practice Address - Country:US
Practice Address - Phone:419-394-4813
Practice Address - Fax:419-394-1546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH20049876Medicaid
OH20049876Medicaid