Provider Demographics
NPI:1790916377
Name:CHACON, MARTHA MEGAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:MEGAN
Last Name:CHACON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:CHACON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:988102 NEBRASKA MEDICAL CTR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68198-8102
Mailing Address - Country:US
Mailing Address - Phone:402-559-4081
Mailing Address - Fax:402-559-7372
Practice Address - Street 1:988102 NEBRASKA MEDICAL CTR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-8102
Practice Address - Country:US
Practice Address - Phone:402-559-4081
Practice Address - Fax:402-559-7372
Is Sole Proprietor?:No
Enumeration Date:2009-07-30
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NENE-TEP 6131207R00000X
NE27874207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine