Provider Demographics
NPI:1477584399
Name:ALAPPATT, CHACKO J (MD)
Entity Type:Individual
Prefix:DR
First Name:CHACKO
Middle Name:J
Last Name:ALAPPATT
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 1:60 REMICK BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-9168
Mailing Address - Country:US
Mailing Address - Phone:937-886-5510
Mailing Address - Fax:937-886-5595
Practice Address - Street 1:60 REMICK BLVD
Practice Address - Street 2:
Practice Address - City:SPRINGBORO
Practice Address - State:OH
Practice Address - Zip Code:45066-9168
Practice Address - Country:US
Practice Address - Phone:937-886-5510
Practice Address - Fax:937-886-5595
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35078283207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH204449063OtherTAX ID#
OH308717OtherAMERIGROUP ID#
OH000000492761OtherANTHEM ID#
OH2194601Medicaid
OH308717OtherAMERIGROUP ID#