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General NPI Number Information
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NPI Number | 1972695872
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Entity Type | Individual
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Provider Name | JOHN KABZEEL YESUDAS CHACKO M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 09/26/2007
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Provider Practice Location Address
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Address Line | 3212 CHURCHLAND BOULEVARD SUITE 8
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City | CHESAPEAKE
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State | VA
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Zip | 23321-5206
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Country | US
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Telephone | 757-399-0886
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Fax | 757-399-1191
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Provider Business Mailing Address
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Address Line | 3212 CHURCHLAND BOULEVARD SUITE 8
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City | CHESAPEAKE
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State | VA
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Zip | 23321
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Country | US
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Telephone | 757-399-0886
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Fax | 757-399-1191
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 0101037065
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 0101037065
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number | 0101037065
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License Number State | VA
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