1790848950 NPI number — DR. DOSSU J CHANDUWADIA M.D.

Table of content: DR. DOSSU J CHANDUWADIA M.D. (NPI 1790848950)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790848950 NPI number — DR. DOSSU J CHANDUWADIA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHANDUWADIA
Provider First Name:
DOSSU
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WADIA
Provider Other First Name:
DJC
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1790848950
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 US HIGHWAY 61
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
FESTUS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63028-4100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-933-6070
Provider Business Mailing Address Fax Number:
636-933-0942

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 US HIGHWAY 61
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
FESTUS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63028-4100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-933-6070
Provider Business Practice Location Address Fax Number:
636-933-0942
Provider Enumeration Date:
12/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  MD35388 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 07154 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 241846 . This is a "HEALTHLINK NUMBER" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 7286 . This is a "GHP NUMBER" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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