MYSTY CHACKO


Address: 132 S 10th St, Philadelphia, PA 19107-5244
Phone: 2159558900

MYSTY CHACKO (NPI# 1669003745) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1669003745
Entity Type Individual
Full Name MYSTY CHACKO
Credential PA-C
Practice Address 132 S 10th St
Philadelphia
PA 19107-5244
Mailing Address 132 S 10th Street
480 Main Building
Phila
PA 19107
Practice Telephone 2159558900
Mailing Telephone 2159558900
Mailing Fax Number 2159555245
Enumeration Date 2020-01-28
Last Update Date 2020-02-08
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 207RG0100X Internal Medicine
Specialization: Gastroenterology
MA061392 PA Allopathic & Osteopathic Physicians

Provider Secondary Practice Location

Address Telephone Number Fax Number
132 S 10th St, Philadelphia, PA 191075244 8005333669

Office Location

Street Address 132 S 10TH ST
City PHILADELPHIA
State PA
Zip Code 19107-5244

Providers in the same location

NPI Name Taxonomy Address Enumeration
1275521353 Charalambos C Solomides Pathology 132 S 10th St, Main Building 285k, Philadelphia, PA 19107-5244 2005-10-12
1801430228 Kimberly Irene Ward Physician Assistant 132 S 10th St, Philadelphia, PA 19107-5244 2019-10-29
1316597073 Alyssa Angradi Physician Assistant 132 S 10th St, Philadelphia, PA 19107-5244 2019-09-16
1790335412 Sarah Alexandra Ackerman Nurse Practitioner 132 S 10th St, Philadelphia, PA 19107-5244 2019-09-14
1972150399 Danielle Marotta Nurse Practitioner 132 S 10th St, Philadelphia, PA 19107-5244 2019-08-21
1649825795 Methodist Associates In Healthcare, Inc. Internal Medicine 132 S 10th St, Philadelphia, PA 19107-5244 2019-08-06
1023672029 Rahed Mohammed Student in an Organized Health Care Education/Training Program 132 S 10th St, Philadelphia, PA 19107-5244 2019-04-24
1265095889 Ryan Matthew Sutton Student in an Organized Health Care Education/Training Program 132 S 10th St, Philadelphia, PA 19107-5244 2019-04-18
1821551706 Jason Ho Student in an Organized Health Care Education/Training Program 132 S 10th St, Philadelphia, PA 19107-5244 2019-04-09
1144784059 Mary Szymanski Nurse Practitioner 132 S 10th St, Philadelphia, PA 19107-5244 2019-01-24
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1578170940 Stephanie Quist Pharmacist 1 S Broad Street, Philadelphia, PA 19107 2020-09-29
1457968448 Cloudline Physical Therapy LLC Physical Therapist 239-241 South 10th St, Philadelphia, PA 19107 2020-09-24
1053931303 Wilson Wong Pharmacist Cvs Pharmacy #450, 3401 Walnut St, Philadelphia, PA 19107 2020-04-16
1326608779 Pascal Lavergne Neurological Surgery 111 11th St, Thomas Jefferson University, Philadelphia, PA 19107 2019-06-18
1639632185 Taylor D'amore Orthopaedic Surgery 925 Chest Street 5th Floor, Philadelphia, PA 19107 2019-04-11
1043779630 Heather Lynn Yenser Nurse Practitioner 111 S. 11th St., Jefferson Vascular Center (6th Floor), Philadelphia, PA 19107 2019-03-14
1174093702 Jennifer Lynn Kengeter Psychologist 900 Walnut Street, Suite 200, Philadelphia, PA 19107 2018-11-27
1649751843 Rachel Wint Physician Assistant 231 N Broad St Fl 2, Philadelphia, PA 19107 2018-08-24
1922588623 Hyung Bin Lee Dentist 315 N 12th St, Apt 803, Philadelphia, PA 19107 2018-08-21
1750860490 Anastasiya Khlypnych Physician Assistant 111 S. 11th Street, Suite 2170, Gibbon Bldg Suite 6210, Philadelphia, PA 19107 2018-08-13
Find all providers in zip 19107

Taxonomy Information

Taxonomy Code 207RG0100X
Grouping Allopathic & Osteopathic Physicians
Classification Internal Medicine
Specialization Gastroenterology

Taxonomy Definition

An internist who specializes in diagnosis and treatment of diseases of the digestive organs including the stomach, bowels, liver and gallbladder. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using endoscopes to visualize internal organs.
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source]
- Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification
- Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1013150796 Richard Mao Wu Internal Medicine 132 S. 10th Street, Main Bldg, Ste 430, Philadelphia, PA 19107 2009-04-11
1811148430 Kian Makipour Internal Medicine 3401 North Broad St, Philadelphia, PA 19130 2008-10-01
1982865127 Shivan Jatin Mehta Internal Medicine 423 Guardian Dr, Blockley Hall 1137, Philadelphia, PA 19104-4865 2008-06-20
1730204355 Rahul Anand Nathwani Internal Medicine 132 S 10th St Ste 480, Philadelphia, PA 19107-5244 2007-03-20
1386729705 Blake Gastroenterology Associates, LLC Internal Medicine 6827-31 Germantown Ave, Philadelphia, PA 19119-2113 2006-10-25
1942393830 John Patrick Lynch Internal Medicine 415 Curie Blvd, 600 Crb, Philadelphia, PA 19104-4306 2006-10-02
1962428433 Keith Joseph Buhl Internal Medicine 1403 Rhawn Street, Philadelphia, PA 19111-2430 2006-07-15
1366476020 Michael J Rosner Internal Medicine 4242 Cottman Ave, Philadelphia, PA 19135-1118 2006-07-10
1558300152 Xiaoli Ma Internal Medicine 121 N 9th St, Philadelphia, PA 19107-2410 2006-06-06
1275571945 Oleg Volchonok Internal Medicine 11400 Bustleton Ave, Philadelphia, PA 19116-2815 2006-06-03
Find all providers in PHILADELPHIA

Competitor

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City PHILADELPHIA
Zip Code 19107

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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