MEDICARE: CHELSEA A SMALLRIDGE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	MA056923	PA
2	363A00000X	Physician Assistant	OA003313	PA

General Provider Information

NPI Number	:	1902211279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHELSEA A SMALLRIDGE

Provider Business Mailing Address
First Line	:	450 CRESSON BOULEVARD
Second Line	:	SUITE 110 BOX 876
City	:	OAKS
State	:	PA
Zip	:	19456-1109
Country	:	US
Telephone Number	:	610-728-6100
Fax Number	:	610-728-6071

Provider Business Practice Location Address
First Line	:	450 CRESSON BOULEVARD
Second Line	:	SUITE 110 BOX 876
City	:	OAKS
State	:	PA
Zip	:	19456-1109
Country	:	US
Telephone Number	:	610-728-6100
Fax Number	:	610-728-6071

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2014
Last Update Date	:	06/25/2014

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Directions to “ CHELSEA A SMALLRIDGE ” Practice Location

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