Provider Demographics
NPI:1558408021
Name:CHUKE, JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:CHUKE
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 1:15005 SHADY GROVE RD STE 240
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-6364
Mailing Address - Country:US
Mailing Address - Phone:301-217-0979
Mailing Address - Fax:301-294-4095
Practice Address - Street 1:15005 SHADY GROVE RD STE 240
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-6364
Practice Address - Country:US
Practice Address - Phone:301-217-0979
Practice Address - Fax:301-294-4095
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2017-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD31537207R00000X
MDD0054508207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
011775K92Medicare ID - Type Unspecified
H84924Medicare UPIN