Basic Information
| Provider Information | |||||||||
| NPI: | 1518301019 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHACKO | ||||||||
| FirstName: | CHARLES ANDREW | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 ROSE ST STE CC-402 | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405360293 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593231786 | ||||||||
| FaxNumber: | 8592577715 | ||||||||
| Practice Location | |||||||||
| Address1: | UNIVERSITY OF KENTUCKY | ||||||||
| Address2: | 800 ROSE STREET | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 40536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593232636 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2013 | ||||||||
| LastUpdateDate: | 06/26/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 129436 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 4301102344 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RH0003X | 51219 | KY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
No ID Information.