Provider Demographics
NPI:1740388933
Name:CHINNASWAMY, CHITRA (MD)
Entity Type:Individual
Prefix:MRS
First Name:CHITRA
Middle Name:
Last Name:CHINNASWAMY
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 1:1801 NW PLATTE RD
Mailing Address - Street 2:STE 200
Mailing Address - City:RIVERSIDE
Mailing Address - State:MO
Mailing Address - Zip Code:64150-7509
Mailing Address - Country:US
Mailing Address - Phone:816-454-8475
Mailing Address - Fax:816-454-8487
Practice Address - Street 1:1801 NW PLATTE RD
Practice Address - Street 2:STE 200
Practice Address - City:RIVERSIDE
Practice Address - State:MO
Practice Address - Zip Code:64150-7509
Practice Address - Country:US
Practice Address - Phone:816-454-8475
Practice Address - Fax:816-454-8487
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2014-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMD1005942084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208536623Medicaid
0009635Medicare ID - Type Unspecified