Individual
DR. JUSTIN CHACKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2601 HOLME AVE, PHILADELPHIA, PA 19152-2007
(855) 768-6363
Mailing address
501 MADISON AVE, SCRANTON, PA 18510-2401
(570) 343-2383
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
CL0262
NV
207R00000X
Internal Medicine Physician
OT016725
PA
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
CL0262
NV
Other
Enumeration date
06/18/2015
Last updated
03/25/2026
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