Basic Information
| Provider Information | |||||||||
| NPI: | 1740487537 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHALASANI | ||||||||
| FirstName: | NAGAMALA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 60447 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282600447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043845416 | ||||||||
| FaxNumber: | 7043845992 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 HAWTHORNE LN | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282042515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043845416 | ||||||||
| FaxNumber: | 7043845992 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2007 | ||||||||
| LastUpdateDate: | 10/25/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 239583 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 2013-00220 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 2013-00220 | NC | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | FC1398836 | 01 | DEA | OTHER | 1740487537 | 01 | MA | NETWORK HEALTH | OTHER | MC0756936A | 01 | MA | MASS. CONTROLLED SUBSTANCE | OTHER | J46234 | 01 | MA | BC/BS OF MASSACHUSETTS | OTHER | 1740487537 | 01 | MA | NHP | OTHER |