Sumy Chacko, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

C0004157 Issued in MD

Practice address

18101 Prince Philip Dr
Olney, MD 20832-1514

Phone

(301) 774-4105

NPI assigned

Feb 15, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Mrs. Sumy Chacko Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1269907200000",
    "number": "1508909045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2429 EPSTEIN CT",
            "city": "BROOKEVILLE",
            "state": "MD",
            "postal_code": "208333263",
            "telephone_number": "516-313-5928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18101 PRINCE PHILIP DR",
            "city": "OLNEY",
            "state": "MD",
            "postal_code": "208321514",
            "telephone_number": "301-774-4105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHACKO",
        "first_name": "SUMY",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-15",
        "last_updated": "2010-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "011290",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MD",
            "license": "C0004157",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUMY",
            "last_name": "CHACKO",
            "prefix": "MRS.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Surgical Physician Assistant in Olney, MD
• Providers in Olney, MD by specialty
• Surgical Physician Assistant in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.