Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204F00000X | Transplant Surgeon | 113503 | MO |
Y | 208200000X | Surgeon | 113503 | MO |
Y | 208600000X | Surgeon | 113503 | MO |
N | 208200000X | Surgeon | MD428212 | PA |
N | 208600000X | Surgeon | MD428212 | PA |
NPI | 1083665574 |
---|---|
Provider Name | Mr. Chintalapati Varma |
First Address | St. Louis, MO 63110 |
Second Address | Saint Louis, MO 63104-1016 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 23/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
101503938 | (05) | PA |
G40110 | (02) |