Provider Demographics
NPI:1659718765
Name:DENNIS, CHATRIECE ANDREA (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:CHATRIECE
Middle Name:ANDREA
Last Name:DENNIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CHATRIECE
Other - Middle Name:ANDREA
Other - Last Name:LAWSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:31516 WINTERPLACE PKWY STE 103
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-2417
Mailing Address - Country:US
Mailing Address - Phone:410-334-6351
Mailing Address - Fax:410-334-6352
Practice Address - Street 1:2425 N SALISBURY BLVD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-2138
Practice Address - Country:US
Practice Address - Phone:410-334-6351
Practice Address - Fax:410-334-6352
Is Sole Proprietor?:No
Enumeration Date:2013-05-30
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0005049363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant