Provider Demographics
NPI:1952418998
Name:GETYINA, CHAD GABRIEL (PA)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:GABRIEL
Last Name:GETYINA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1902 BRAEBURN DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-7304
Mailing Address - Country:US
Mailing Address - Phone:540-444-8100
Mailing Address - Fax:540-772-2583
Practice Address - Street 1:1902 BRAEBURN DR
Practice Address - Street 2:SUITE 130
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-7304
Practice Address - Country:US
Practice Address - Phone:540-444-8100
Practice Address - Fax:540-772-2583
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001000259363A00000X
VA0110002396363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010323983Medicaid
04/30/1974OtherDATE OF BIRTH
VA1952418998Medicaid
011116C21Medicare PIN
P00753513Medicare PIN
VAP01564248Medicare PIN
04/30/1974OtherDATE OF BIRTH
VA1952418998Medicaid
VAVV9135DMedicare PIN