Provider Demographics
NPI:1205827656
Name:CHAWLA, ANWANTBIR (MD)
Entity type:Individual
Prefix:
First Name:ANWANTBIR
Middle Name:
Last Name:CHAWLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ANWANT
Other - Middle Name:
Other - Last Name:CHAWLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1375 CORPORATE SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-3147
Mailing Address - Country:US
Mailing Address - Phone:985-726-2655
Mailing Address - Fax:985-643-9808
Practice Address - Street 1:104 SMART PL
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2040
Practice Address - Country:US
Practice Address - Phone:985-774-6377
Practice Address - Fax:985-726-5158
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-03
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10977R2084P0800X
MS123522084P0800X
TNMD00000200572084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
990007717OtherRAILROAD MEDICARE
LA1923176Medicaid
MS00014057Medicaid
LA1923176Medicaid
LA5U837Medicare PIN
MS260000235Medicare PIN