Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 48675 | WI |
N | 111NI0900X | Internist | 48675 | WI |
N | 207R00000X | Internist | MD52058 | SC |
N | 111NI0900X | Internist | MD52058 | SC |
Y | 207RR0500X | Rheumatology | MD52058 | SC |
NPI | 1063618080 |
---|---|
Provider Name | Dr. Sreelatha Chalasani |
First Address | Rock Hill, SC 29732-3288 |
Second Address | Rock Hill, SC 29732-3288 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2007 |
Last Update Date | 30/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MD52058 | SC LICENSE (01) | SC |