Provider Demographics
NPI:1831139336
Name:CHIENKU, CONSTANTINE N (MD)
Entity Type:Individual
Prefix:
First Name:CONSTANTINE
Middle Name:N
Last Name:CHIENKU
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 1:4701 YOWELL LANE
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:VA
Mailing Address - Zip Code:20115
Mailing Address - Country:US
Mailing Address - Phone:540-364-4398
Mailing Address - Fax:540-349-3231
Practice Address - Street 1:45 N HILL DR
Practice Address - Street 2:SUITE 202
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-2609
Practice Address - Country:US
Practice Address - Phone:540-347-0180
Practice Address - Fax:540-349-3231
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA010266823208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA752699OtherNCPPO
VA541182305OtherUNITED HEALTHCARE
VA199786OtherANTHEM
VA541182305OtherTRICARE
VA8146917OtherMAMSI
VA010266823Medicaid
VA2146917OtherMAMSI
VA3052918OtherCIGNA
VA305773Medicaid
VA437472OtherSOUTHERN HEALTH