Provider Demographics
NPI:1073096913
Name:CAMERLENGO, CHELSEA M (PA-C)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:M
Last Name:CAMERLENGO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 COMMERCE STREET
Mailing Address - Street 2:
Mailing Address - City:WELLSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26070
Mailing Address - Country:US
Mailing Address - Phone:304-737-4435
Mailing Address - Fax:304-737-4439
Practice Address - Street 1:1006 COMMERCE STREET
Practice Address - Street 2:
Practice Address - City:WELLSBURG
Practice Address - State:WV
Practice Address - Zip Code:26070
Practice Address - Country:US
Practice Address - Phone:304-737-4435
Practice Address - Fax:304-737-4439
Is Sole Proprietor?:No
Enumeration Date:2018-09-06
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2184363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0393680Medicaid