Provider Demographics
NPI:1821014127
Name:GYAWALI, CHANDRA PRAKASH (MD)
Entity Type:Individual
Prefix:DR
First Name:CHANDRA
Middle Name:PRAKASH
Last Name:GYAWALI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-747-2066
Mailing Address - Fax:314-747-7111
Practice Address - Street 1:4921 PARKVIEW PL
Practice Address - Street 2:DIV IM GASTROENTEROLOGY, STE 12B
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-747-2066
Practice Address - Fax:314-747-7111
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2024-04-10
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Provider Licenses
StateLicense IDTaxonomies
MO103452207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO203958509Medicaid
ILENROLLEDMedicaid
MO013310183Medicare PIN
MO013310183Medicaid