Provider Demographics
NPI:1033128574
Name:CYRIAC, CHACKMUKAL V (MD)
Entity Type:Individual
Prefix:
First Name:CHACKMUKAL
Middle Name:V
Last Name:CYRIAC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8021 RITCHIE HWY
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-1016
Mailing Address - Country:US
Mailing Address - Phone:410-761-8200
Mailing Address - Fax:410-761-1331
Practice Address - Street 1:8021 RITCHIE HWY
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-1016
Practice Address - Country:US
Practice Address - Phone:410-761-8200
Practice Address - Fax:410-761-1331
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD21684207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
03152154647401OtherUNITED HEALTHCARE
110203468OtherRAILROAD MEDICARE
MD30837006OtherBLUESHIELD OF MARYLAND
MD775611900Medicaid
110203468OtherRAILROAD MEDICARE
MDB69124Medicare UPIN