Provider Demographics
NPI:1598759557
Name:CHACKO, BINU T (MD)
Entity Type:Individual
Prefix:DR
First Name:BINU
Middle Name:T
Last Name:CHACKO
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 1:291 STONER AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-5647
Mailing Address - Country:US
Mailing Address - Phone:410-848-2449
Mailing Address - Fax:410-848-2798
Practice Address - Street 1:291 STONER AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5647
Practice Address - Country:US
Practice Address - Phone:410-848-2449
Practice Address - Fax:410-848-2798
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD52035207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD522117444 21157 A001OtherTRICARE
MD54815704OtherBCBS RENDERING
MDKH04CAOtherBCBS OF MARYLAND
MD801369OtherJOHNS HOPKINS HEALTHCARE
MD625098OtherUNITED HEALTHCARE
MD86197OtherMAMSI
MH653LMedicare ID - Type Unspecified
MD522117444 21157 A001OtherTRICARE
MD255DMedicare ID - Type UnspecifiedRENDERING