Provider Demographics
NPI:1366565103
Name:CHAGANTI AND ASSOCIATES PC
Entity type:Organization
Organization Name:CHAGANTI AND ASSOCIATES PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SURENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAGANTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-283-8291
Mailing Address - Street 1:713 THE HAMPTONS LANE
Mailing Address - Street 2:
Mailing Address - City:TOWN AND COUNTRY
Mailing Address - State:MO
Mailing Address - Zip Code:63017
Mailing Address - Country:US
Mailing Address - Phone:314-276-8893
Mailing Address - Fax:314-645-6478
Practice Address - Street 1:2639 MIAMI STREET
Practice Address - Street 2:
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63118
Practice Address - Country:US
Practice Address - Phone:314-268-6195
Practice Address - Fax:314-268-6155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty