Provider Demographics
NPI:1265622369
Name:CHACKO, RIYA SUSAN (MD)
Entity type:Individual
Prefix:DR
First Name:RIYA
Middle Name:SUSAN
Last Name:CHACKO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:207 N BROAD ST FL 3
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-1500
Mailing Address - Country:US
Mailing Address - Phone:610-696-2850
Mailing Address - Fax:610-696-7159
Practice Address - Street 1:915 OLD FERN HILL RD
Practice Address - Street 2:BLDG A STE 5
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-4269
Practice Address - Country:US
Practice Address - Phone:610-696-2850
Practice Address - Fax:610-696-7159
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD470439207RC0000X
MA233508207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1037748040001Medicaid
NY03529884Medicaid
NYJ400084342Medicare PIN