Provider Demographics
NPI:1497036149
Name:GOODBROD, CHELSEY M (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CHELSEY
Middle Name:M
Last Name:GOODBROD
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 1:310 STOCK ST STE 3
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-2276
Mailing Address - Country:US
Mailing Address - Phone:717-316-6927
Mailing Address - Fax:
Practice Address - Street 1:310 STOCK ST STE 3
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-2276
Practice Address - Country:US
Practice Address - Phone:717-316-6927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-07
Last Update Date:2021-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA056841363A00000X, 363AM0700X
MDC0004545363A00000X
PAOA003411363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical