Provider Demographics
NPI:1457341620
Name:CHICKO, BRETT A (DPM)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:A
Last Name:CHICKO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 CENTRAL PARK BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-4932
Mailing Address - Country:US
Mailing Address - Phone:540-785-7000
Mailing Address - Fax:540-785-7005
Practice Address - Street 1:1420 CENTRAL PARK BLVD STE 200
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4932
Practice Address - Country:US
Practice Address - Phone:540-785-7000
Practice Address - Fax:540-785-7005
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01554213ES0103X
VA0103300938213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC353393YX82OtherMEDICARE NUMBER
MD079289600Medicaid
DC408698OtherGROUP PTAN
DC1285767723OtherGROUP NPI
DC353393YX82OtherMEDICARE NUMBER