Provider Demographics
NPI:1548218126
Name:CHALKO, CHARLES P (DO)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:P
Last Name:CHALKO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:541 MAIN ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SOUTH WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-1868
Mailing Address - Country:US
Mailing Address - Phone:781-952-1240
Mailing Address - Fax:781-952-1257
Practice Address - Street 1:541 MAIN ST
Practice Address - Street 2:SUITE 400
Practice Address - City:SOUTH WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-1868
Practice Address - Country:US
Practice Address - Phone:781-952-1240
Practice Address - Fax:781-952-1257
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA76091207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3094588Medicaid
MA3094588Medicaid
MAF35147Medicare UPIN