Provider Demographics
NPI:1790848950
Name:CHANDUWADIA, DOSSU J (MD)
Entity Type:Individual
Prefix:DR
First Name:DOSSU
Middle Name:J
Last Name:CHANDUWADIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DJC
Other - Middle Name:
Other - Last Name:WADIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1400 US HIGHWAY 61
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-4100
Mailing Address - Country:US
Mailing Address - Phone:636-933-6070
Mailing Address - Fax:636-933-0942
Practice Address - Street 1:1400 US HIGHWAY 61
Practice Address - Street 2:SUITE 110
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-4100
Practice Address - Country:US
Practice Address - Phone:636-933-6070
Practice Address - Fax:636-933-0942
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMD35388207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO07154OtherBLUE CROSS BLUE SHIELD
MO241846OtherHEALTHLINK NUMBER
MO7286OtherGHP NUMBER
MO7286OtherGHP NUMBER