Provider Demographics
NPI:1053313106
Name:PETERSON, CHAD HERBERT (PA)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:HERBERT
Last Name:PETERSON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2675 BIG SEWICKLEY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SEWICKLEY
Mailing Address - State:PA
Mailing Address - Zip Code:15143-8642
Mailing Address - Country:US
Mailing Address - Phone:412-480-7022
Mailing Address - Fax:208-567-0384
Practice Address - Street 1:1307 FEDERAL ST
Practice Address - Street 2:2ND FL ALLEGHENY ORTHOPAEDIC ASSOCS
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4705
Practice Address - Country:US
Practice Address - Phone:877-660-6777
Practice Address - Fax:412-359-8055
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA003277L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP36706Medicare UPIN
PAP00195117Medicare PIN
PA065006NH3Medicare PIN