Provider Demographics
NPI:1306264932
Name:NATESAN, PUJA MANCHIRA (MD)
Entity type:Individual
Prefix:DR
First Name:PUJA
Middle Name:MANCHIRA
Last Name:NATESAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:801 HAZELWEST DR STE 100
Mailing Address - Street 2:
Mailing Address - City:HAZELWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63042-1754
Mailing Address - Country:US
Mailing Address - Phone:143-919-2700
Mailing Address - Fax:314-919-2777
Practice Address - Street 1:801 HAZELWEST DR STE 100
Practice Address - Street 2:
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-1754
Practice Address - Country:US
Practice Address - Phone:314-919-2700
Practice Address - Fax:314-919-2777
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-01
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR4111207Q00000X
OH390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program