Provider Demographics
NPI:1184621427
Name:MATHEWS, CHAD JASON (PA-C)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:JASON
Last Name:MATHEWS
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 1:2501 SHENANGO VALLEY FWY
Mailing Address - Street 2:STE 1
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-2536
Mailing Address - Country:US
Mailing Address - Phone:724-983-1820
Mailing Address - Fax:724-983-1822
Practice Address - Street 1:2501 SHENANGO VALLEY FWY
Practice Address - Street 2:STE 1
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-2536
Practice Address - Country:US
Practice Address - Phone:724-983-1820
Practice Address - Fax:724-983-1822
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA050889363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00204849OtherRAILROAD MEDICARE
PA087714TP0Medicare ID - Type Unspecified