Provider Demographics
NPI:1902010408
Name:CHASKO, MARY THERESA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:THERESA
Last Name:CHASKO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:THERESA
Other - Last Name:CHASKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2101 E JEFFERSON ST
Mailing Address - Street 2:KAISER PERMANENTE MEDICARE ENROLLMENT
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-2424
Mailing Address - Fax:
Practice Address - Street 1:10810 CONNECTICUT AVE
Practice Address - Street 2:KAISER PERMANENTE KENSINGTON MEDICAL CENTER
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-2138
Practice Address - Country:US
Practice Address - Phone:301-929-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD040259207L00000X
VA0101250932207L00000X
PAMD431249207LP2900X, 207L00000X
MDD73405207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA002056193OtherHIGHMARK BLUE SHIELD
PA102165970 0001Medicaid
PA6802733OtherAETNA HMO (PMFC)
PAMD431249OtherMEDICAL LICENSE
PA25-1716306OtherMULTIPLAN/PHCS
PA9695183OtherAETNA NON-HMO
PAG920-0096/914765-04OtherCAREFIRST (PMFC)
PAPEARLOtherHEALTH AMERICA
PA050514OtherMEDICARE GROUP PIN
PA1885935OtherAETNA HMO (AFC)
PA25-1716306OtherHEALTHNET/TRICARE
PA25-1716306OtherSOUTH CENTRAL PREFERRED
PA25-1716306OtherFIRST HEALTH
PA1581407OtherGATEWAY (PMFC)
PAG920-0096/85XWCUOtherCAREFIRST (AFC)
PA1569261OtherGATEWAY (AFC)
PA2183091OtherMAMSI
PA259792OtherUNISON (PMFC)
PA50078618OtherCAPITAL BLUECROSS
PA120420418OtherDEPT OF LABOR
PA245630OtherUNISON (AFC)
PA25-1716306OtherINFORMED
PA25-1716306OtherGREATWEST
PA25-1716306OtherDEVON
PA25-1716306OtherINTERGROUP
PAP00618655OtherRAILROAD MEDICARE
PAP00618655OtherRAILROAD MEDICARE
PA126672P1KMedicare PIN