Physician Compare National (NPI:1407956907)

HEALTHCARE PROVIDER: MATHEW MELOOTTU 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	1407956907
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2668546490
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20080728000722
	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	MATHEW
	Individual professional first name
Provider Middle Name	M
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1974
	Individual professional's medical school graduation year
Primary Specialty	NEUROLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	317 E MAIN ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 1
	Group Practice or individual's line 2 address
City	SMITHTOWN
	Group Practice or individual's city
State	NY
	Group Practice or individual's state
Zip Code	117872818
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y