Physician Compare National (NPI:1356443089)

HEALTHCARE PROVIDER: THOMAS CHACKO MD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1356443089
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7517067788
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20070717000678
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	CHACKO
	Individual professional last name
Provider First Name	THOMAS
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	JEFFERSON MEDICAL COLLEGE OF THOMAS JEFFERSON UNIVERSITY
	Individual professional's medical school
Graduation Year	2002
	Individual professional's medical school graduation year
Primary Specialty	ALLERGY/IMMUNOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	102 MARY ALICE PARK RD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 805
	Group Practice or individual's line 2 address
City	CUMMING
	Group Practice or individual's city
State	GA
	Group Practice or individual's state
Zip Code	300402664
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y