Provider Demographics
NPI:1780630947
Name:CHALASANI, MADHU P (MD)
Entity Type:Individual
Prefix:
First Name:MADHU
Middle Name:P
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 1:8050 BECKETT CENTER DR STE 108
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-5024
Mailing Address - Country:US
Mailing Address - Phone:513-618-7430
Mailing Address - Fax:513-280-8868
Practice Address - Street 1:8050 BECKETT CENTER DR STE 108
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-5024
Practice Address - Country:US
Practice Address - Phone:513-618-7430
Practice Address - Fax:513-280-8868
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-079504208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2274720Medicaid
OH000000509620OtherBCBS
OH000000509620OtherBCBS
OH4058386Medicare PIN
H46186Medicare UPIN
OHCH4058385Medicare PIN