Provider Demographics
NPI:1467569053
Name:CHACKO, VARUGHESE P (MD)
Entity Type:Individual
Prefix:DR
First Name:VARUGHESE
Middle Name:P
Last Name:CHACKO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:970 N BROADWAY
Mailing Address - Street 2:308B
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701
Mailing Address - Country:US
Mailing Address - Phone:914-423-8000
Mailing Address - Fax:914-423-4833
Practice Address - Street 1:970 N BROADWAY
Practice Address - Street 2:308B
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701
Practice Address - Country:US
Practice Address - Phone:914-423-8000
Practice Address - Fax:914-423-4833
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY194069207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
2503832OtherGHI
WP646OtherOXFORD
NY01446208Medicaid
NY04I501OtherBCBS
0H4781OtherACS HEALTHNET
NYF70419Medicare UPIN
NY04I501Medicare PIN