Healthcare Provider Details

I. General information

NPI: 1437654662
Provider Name (Legal Business Name): ERIC JOSEPH CHACKO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2018
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 SHERMAN AVE STE 405
NEW HAVEN CT
06511-5210
US

IV. Provider business mailing address

136 SHERMAN AVE STE 405
NEW HAVEN CT
06511-5210
US

V. Phone/Fax

Practice location:
  • Phone: 203-787-0117
  • Fax: 203-777-3559
Mailing address:
  • Phone: 203-787-0117
  • Fax: 203-777-3559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number74328
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: