Healthcare Provider Details

I. General information

NPI: 1902010408
Provider Name (Legal Business Name): MARY THERESA CHASKO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY THERESA CHASKO M.D.

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 03/07/2023
Certification Date: 06/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10810 CONNECTICUT AVE KAISER PERMANENTE KENSINGTON MEDICAL CENTER
KENSINGTON MD
20895-2138
US

IV. Provider business mailing address

2101 E JEFFERSON ST KAISER PERMANENTE MEDICARE ENROLLMENT
ROCKVILLE MD
20852-4908
US

V. Phone/Fax

Practice location:
  • Phone: 301-929-7100
  • Fax:
Mailing address:
  • Phone: 301-816-2424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD040259
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0101250932
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD431249
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberD73405
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD431249
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: