Individual
MYSTY CHACKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
400 W ROUTE 38, MOORESTOWN, NJ 08057-3219
(856) 270-4000
Mailing address
1 FEDERAL ST STE 200, CAMDEN, NJ 08103-1088
(848) 288-6935
(732) 790-0107
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
MA061392
PA
363A00000X
Physician Assistant
Primary
25MP00866300
NJ
Other
Enumeration date
01/28/2020
Last updated
08/07/2024
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