Individual
SURYAMOL A CHACKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8605 RIGLEY'S CHOICE DR, BALTIMORE, MD 21236
(855) 546-2001
Mailing address
9600 PULASKI PARK DRIVE, SUITE 103, MEDSTAR MEDICAL GROUP, C/O LINDSAY SMOOT, BALTIMORE, MD 21220
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R168493
MD
363LF0000X
Family Nurse Practitioner
Primary
R168493
MD
Other
Enumeration date
06/26/2015
Last updated
06/26/2015
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