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General NPI Number Information
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NPI Number | 1932456605
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Entity Type | Individual
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Provider Name | MARY ANNE SAPNA CHACKO M.D., PHD
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Gender | Female
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Dates
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Enumeration Date | 08/12/2012
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Last Update Date | 10/23/2024
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Provider Practice Location Address
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Address Line | 1752 BROAD PARK CIR N STE 114
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City | MANSFIELD
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State | TX
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Zip | 76063-7824
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Country | US
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Telephone | 855-893-5637
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Fax | 817-666-3873
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Provider Business Mailing Address
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Address Line | 2340 E TRINITY MILLS RD STE 250
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City | CARROLLTON
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State | TX
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Zip | 75006-1946
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Country | US
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Telephone | 817-886-4455
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | Q7337
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License Number State | TX
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