Provider Demographics
NPI:1932213725
Name:CHAGANTI, SURENDRA (MD)
Entity type:Individual
Prefix:
First Name:SURENDRA
Middle Name:
Last Name:CHAGANTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:713 THE HAMPTONS LN
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-5901
Mailing Address - Country:US
Mailing Address - Phone:314-283-8291
Mailing Address - Fax:888-640-9853
Practice Address - Street 1:3507 TEXAS AVE
Practice Address - Street 2:ST ALEXIUS OFFICE
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63118-3114
Practice Address - Country:US
Practice Address - Phone:314-283-8291
Practice Address - Fax:888-640-9853
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO1079212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
525705OtherHEALTH LINK
114952OtherBLUE CROSS
MO208238303Medicaid
F73238OtherMERCY
119447OtherCIGNA
119447OtherCIGNA
F73238Medicare UPIN