Individual
PADMAJA CHALASANI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
GRAND LAKE PRIMARY CARE AT ST MARYS, 1140 S KNOXVILLE AVE STE A, SAINT MARYS, OH 45885-2609
(419) 394-9959
(419) 394-0255
Mailing address
200 SAINT CLAIR AVE, SAINT MARYS, OH 45885-2400
(419) 300-1129
(419) 394-0255
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
35.074537
OH
207R00000X
Internal Medicine Physician
Primary
35.074537
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2079076
—
OH
01
—
9934723
ORGANIZATIONAL MEDICARE PTAN
OH
01
—
H348972
MEDICARE PTAN
OH
Enumeration date
09/14/2006
Last updated
01/24/2022
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