Provider Demographics
NPI:1508806589
Name:BRICKLEY, CHAD A (PA-C)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:A
Last Name:BRICKLEY
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 1:205 S FRONT ST
Mailing Address - Street 2:BRADY BUILDING - 4TH
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1619
Mailing Address - Country:US
Mailing Address - Phone:717-231-8555
Mailing Address - Fax:717-231-8568
Practice Address - Street 1:205 S FRONT ST
Practice Address - Street 2:BRADY BUILDING - 4TH
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17104-1619
Practice Address - Country:US
Practice Address - Phone:717-231-8555
Practice Address - Fax:717-231-8568
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2012-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA001868L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA232809429008OtherTRICARE
50073444OtherCAPITAL BLUE CROSS
PA970024781OtherRR MEDICARE PTAN
PACA5965OtherRAILROAD MEDICARE
PA232809429008OtherTRICARE
PAR83223Medicare UPIN