Provider Demographics
NPI:1609058916
Name:CHACKER, JASON ERIC (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:ERIC
Last Name:CHACKER
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 1:58 APPLETREE LN
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-3022
Mailing Address - Country:US
Mailing Address - Phone:215-396-4227
Mailing Address - Fax:
Practice Address - Street 1:735 DAVISVILLE RD
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-3282
Practice Address - Country:US
Practice Address - Phone:215-396-4227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-28
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA053242363AM0700X
NJ25MP00215900363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical