Provider Demographics
NPI:1376638189
Name:CHANKO, ERIC H (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:H
Last Name:CHANKO
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 1:28 CANTERBURY RD
Mailing Address - Street 2:
Mailing Address - City:SANDY HOOK
Mailing Address - State:CT
Mailing Address - Zip Code:06482-1583
Mailing Address - Country:US
Mailing Address - Phone:203-364-1119
Mailing Address - Fax:203-364-1119
Practice Address - Street 1:24 HOSPITAL AVE
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810
Practice Address - Country:US
Practice Address - Phone:203-739-6959
Practice Address - Fax:203-749-9031
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT037914207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT110009344Medicare ID - Type Unspecified
CTG97428Medicare UPIN