Provider Demographics
NPI:1972741551
Name:BUCK, SUJATA CHATTERJI (MD)
Entity Type:Individual
Prefix:DR
First Name:SUJATA
Middle Name:CHATTERJI
Last Name:BUCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SUJATA
Other - Middle Name:
Other - Last Name:AIYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4 WEST PINE COURT
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-2110
Mailing Address - Country:US
Mailing Address - Phone:314-454-3831
Mailing Address - Fax:
Practice Address - Street 1:4 WEST PINE COURT
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2110
Practice Address - Country:US
Practice Address - Phone:314-454-3831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006027158208000000X, 2083P0901X
VA0101036604208000000X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine