Provider Demographics
NPI:1942758677
Name:DUCKWALL, CHASE (PA-C)
Entity Type:Individual
Prefix:MR
First Name:CHASE
Middle Name:
Last Name:DUCKWALL
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 1:13620 CRAYTON BLVD
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-2335
Mailing Address - Country:US
Mailing Address - Phone:240-313-3100
Mailing Address - Fax:240-313-3101
Practice Address - Street 1:13620 CRAYTON BLVD
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-2335
Practice Address - Country:US
Practice Address - Phone:240-313-3100
Practice Address - Fax:240-313-3101
Is Sole Proprietor?:No
Enumeration Date:2016-09-12
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
PAMA058998363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical