Provider Demographics
NPI:1760477269
Name:CHALASANI, PRASAD VRK (MD)
Entity Type:Individual
Prefix:MR
First Name:PRASAD
Middle Name:VRK
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 1:1900 NEBRASKA AVENUE
Mailing Address - Street 2:SUITE 9
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4837
Mailing Address - Country:US
Mailing Address - Phone:772-465-4499
Mailing Address - Fax:772-466-0832
Practice Address - Street 1:1900 NEBRASKA AVENUE
Practice Address - Street 2:SUITE 9
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4837
Practice Address - Country:US
Practice Address - Phone:772-465-4499
Practice Address - Fax:772-466-0832
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0072976207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
060053466OtherRAILROAD MEDICARE
FL253894600Medicaid
2071408OtherAETNA HMO
K1415Medicare PIN
060053466OtherRAILROAD MEDICARE
FLF70661Medicare UPIN
F70661Medicare UPIN