Provider Demographics
NPI:1902211279
Name:SMALLRIDGE, CHELSEA A
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:A
Last Name:SMALLRIDGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:A
Other - Last Name:FREESTONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:450 CRESSON BOULEVARD
Mailing Address - Street 2:SUITE 110 BOX 876
Mailing Address - City:OAKS
Mailing Address - State:PA
Mailing Address - Zip Code:19456-1109
Mailing Address - Country:US
Mailing Address - Phone:610-728-6100
Mailing Address - Fax:610-728-6071
Practice Address - Street 1:450 CRESSON BOULEVARD
Practice Address - Street 2:SUITE 110 BOX 876
Practice Address - City:OAKS
Practice Address - State:PA
Practice Address - Zip Code:19456-1109
Practice Address - Country:US
Practice Address - Phone:610-728-6100
Practice Address - Fax:610-728-6071
Is Sole Proprietor?:No
Enumeration Date:2014-06-25
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA056923363A00000X
PAOA003313363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant