Provider Demographics
NPI:1104855907
Name:CASKEY, CHAD S (PA)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:S
Last Name:CASKEY
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 1:725 S COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:24605-1640
Mailing Address - Country:US
Mailing Address - Phone:276-326-3376
Mailing Address - Fax:276-326-3046
Practice Address - Street 1:725 S COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:VA
Practice Address - Zip Code:24605
Practice Address - Country:US
Practice Address - Phone:276-326-3376
Practice Address - Fax:276-326-3046
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV424363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVPENDINGMedicare ID - Type UnspecifiedMWV
Q45906Medicare UPIN