Provider Demographics
NPI:1336495431
Name:SMUCKER, CHAD DANIEL (PA-C)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:DANIEL
Last Name:SMUCKER
Suffix:
Gender:M
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 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2600 PAPERMILL RD
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-3362
Practice Address - Country:US
Practice Address - Phone:484-220-0051
Practice Address - Fax:415-242-6244
Is Sole Proprietor?:No
Enumeration Date:2012-07-26
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60425363A00000X
PAMA056900363A00000X
PAOA003301363A00000X
MDC0005692363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant