Individual
JOHN KABZEEL YESUDAS CHACKO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3212 CHURCHLAND BOULEVARD, SUITE 8, CHESAPEAKE, VA 23321-5206
(757) 399-0886
(757) 399-1191
Mailing address
3212 CHURCHLAND BOULEVARD, SUITE 8, CHESAPEAKE, VA 23321
(757) 399-0886
(757) 399-1191
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
0101037065
VA
2086S0129X
Vascular Surgery Physician
0101037065
VA
208C00000X
Colon & Rectal Surgery Physician
0101037065
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15421
OPTIMA
VA
01
—
174596
ANTHEM BC BS
VA
Enumeration date
09/28/2006
Last updated
09/26/2007
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