Provider Demographics
NPI:1730108986
Name:CHACKO, LEELA ANDUMALY (MD)
Entity Type:Individual
Prefix:MRS
First Name:LEELA
Middle Name:ANDUMALY
Last Name:CHACKO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:7610 CARROLL AVE 390
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20912-6323
Mailing Address - Country:US
Mailing Address - Phone:301-270-5522
Mailing Address - Fax:301-270-4837
Practice Address - Street 1:50 IRVING ST NW
Practice Address - Street 2:VA MEDICAL CENTER
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20422-0001
Practice Address - Country:US
Practice Address - Phone:202-745-8311
Practice Address - Fax:202-518-4695
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2015-10-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
DC12638208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation