Provider Demographics
NPI:1932456605
Name:CHACKO, MARY ANNE SAPNA (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:MARY ANNE
Middle Name:SAPNA
Last Name:CHACKO
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:DR
Other - First Name:MARY ANNE
Other - Middle Name:SAPNA
Other - Last Name:MANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:2340 E TRINITY MILLS RD STE 250
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-1946
Mailing Address - Country:US
Mailing Address - Phone:817-886-4455
Mailing Address - Fax:
Practice Address - Street 1:1752 BROAD PARK CIR N STE 114
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-7824
Practice Address - Country:US
Practice Address - Phone:855-893-5637
Practice Address - Fax:817-666-3873
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-12
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ7337207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine