Individual
MRS. SUMY CHACKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
18101 PRINCE PHILIP DR, OLNEY, MD 20832-1514
(301) 774-4105
Mailing address
2429 EPSTEIN CT, BROOKEVILLE, MD 20833-3263
(516) 313-5928
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
011290
NY
363AS0400X
Surgical Physician Assistant
Primary
C0004157
MD
Other
Enumeration date
02/15/2007
Last updated
03/30/2010
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