Provider Demographics
NPI:1467440354
Name:CHABALKO, JOHN J (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:CHABALKO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3710 KENNETT PIKE
Mailing Address - Street 2:GREENVILLE MEDICAL CENTER II
Mailing Address - City:GREENVILLE
Mailing Address - State:DE
Mailing Address - Zip Code:19807-2157
Mailing Address - Country:US
Mailing Address - Phone:302-623-6333
Mailing Address - Fax:302-623-6306
Practice Address - Street 1:3710 KENNETT PIKE
Practice Address - Street 2:GREENVILLE MEDICAL CENTER II
Practice Address - City:GREENVILLE
Practice Address - State:DE
Practice Address - Zip Code:19807-2157
Practice Address - Country:US
Practice Address - Phone:302-623-6333
Practice Address - Fax:302-623-6306
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DEC10001733207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
4284697OtherAETNA/USHC
DE0000047701Medicaid
PA0084172000OtherAMERIHEALTH/KEYSTONE
PA148720OtherINDEPENDENCE BCBS
DE45427OtherCOVENTRY
1155490001OtherCIGNA
290752OtherMAMSI
PA0084172000OtherAMERIHEALTH/KEYSTONE
B66531Medicare UPIN
290003436Medicare ID - Type UnspecifiedPALMETTO BGA MEDICARE