Provider Demographics
NPI:1366202202
Name:CHAKOUMAKOS, MADISON ANN AFFHOLTER (MD, MS)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:ANN AFFHOLTER
Last Name:CHAKOUMAKOS
Suffix:
Gender:F
Credentials:MD, MS
Other - Prefix:
Other - First Name:MADIE
Other - Middle Name:
Other - Last Name:CHAKOUMAKOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, MS
Mailing Address - Street 1:300 PASTEUR DR
Mailing Address - Street 2:
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-2200
Mailing Address - Country:US
Mailing Address - Phone:415-638-7953
Mailing Address - Fax:
Practice Address - Street 1:300 PASTEUR DR
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-2200
Practice Address - Country:US
Practice Address - Phone:415-638-7953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program