Provider Demographics
NPI:1699717090
Name:CHACHO, MARY S (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:S
Last Name:CHACHO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 HOSPITAL AVE
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-6099
Mailing Address - Country:US
Mailing Address - Phone:203-739-7453
Mailing Address - Fax:
Practice Address - Street 1:24 HOSPITAL AVE
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-6099
Practice Address - Country:US
Practice Address - Phone:203-739-7453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT027421207ZC0500X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT148535OtherOXFORD
CT148535OtherUNITED HEALTHCARE
NY58R691OtherEMPIRE BCBS
CT810730064OtherPHCS
CT010027421CT03OtherANTHEM BCBS
CT042065OtherHEALTH NET
CT397884OtherCIGNA
CT001274216Medicaid
CT1125923OtherAETNA US HEALTHCARE
CTP00293964OtherRAILROAD MEDICARE
CT148535OtherUNITED HEALTHCARE
CT010027421CT03OtherANTHEM BCBS