Basic Information
| Provider Information | |||||||||
| NPI: | 1902010408 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHASKO | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | THERESA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CHASKO | ||||||||
| OtherFirstName: | MARY | ||||||||
| OtherMiddleName: | THERESA | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2101 E JEFFERSON ST | ||||||||
| Address2: | KAISER PERMANENTE MEDICARE ENROLLMENT | ||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208524908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018162424 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 10810 CONNECTICUT AVE | ||||||||
| Address2: | KAISER PERMANENTE KENSINGTON MEDICAL CENTER | ||||||||
| City: | KENSINGTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208952138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3019297100 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2007 | ||||||||
| LastUpdateDate: | 06/17/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 06/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | MD040259 | DC | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 0101250932 | VA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | MD431249 | PA | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207L00000X | D73405 | MD | Y | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | MD431249 | PA | N | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 002056193 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 102165970 0001 | 05 | PA | MEDICAID | 6802733 | 01 | PA | AETNA HMO (PMFC) | OTHER | FB0258663 | 01 | PA | DEA | OTHER | MD431249 | 01 | PA | MEDICAL LICENSE | OTHER | 25-1716306 | 01 | PA | MULTIPLAN/PHCS | OTHER | 9695183 | 01 | PA | AETNA NON-HMO | OTHER | G920-0096/914765-04 | 01 | PA | CAREFIRST (PMFC) | OTHER | PEARL | 01 | PA | HEALTH AMERICA | OTHER | 050514 | 01 | PA | MEDICARE GROUP PIN | OTHER | 1885935 | 01 | PA | AETNA HMO (AFC) | OTHER | 25-1716306 | 01 | PA | HEALTHNET/TRICARE | OTHER | 25-1716306 | 01 | PA | SOUTH CENTRAL PREFERRED | OTHER | 25-1716306 | 01 | PA | FIRST HEALTH | OTHER | 1581407 | 01 | PA | GATEWAY (PMFC) | OTHER | G920-0096/85XWCU | 01 | PA | CAREFIRST (AFC) | OTHER | 1569261 | 01 | PA | GATEWAY (AFC) | OTHER | 2183091 | 01 | PA | MAMSI | OTHER | 259792 | 01 | PA | UNISON (PMFC) | OTHER | 50078618 | 01 | PA | CAPITAL BLUECROSS | OTHER | 120420418 | 01 | PA | DEPT OF LABOR | OTHER | 245630 | 01 | PA | UNISON (AFC) | OTHER | 25-1716306 | 01 | PA | INFORMED | OTHER | 25-1716306 | 01 | PA | GREATWEST | OTHER | 25-1716306 | 01 | PA | DEVON | OTHER | 25-1716306 | 01 | PA | INTERGROUP | OTHER | P00618655 | 01 | PA | RAILROAD MEDICARE | OTHER |