Healthcare Provider Details

I. General information

NPI: 1568015014
Provider Name (Legal Business Name): CHELSEA WAILGUM PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHELSEA ANN MERRITT PA-C

II. Dates (important events)

Enumeration Date: 07/23/2019
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

369 SOUTH ST
PITTSFIELD MA
01201-6803
US

IV. Provider business mailing address

369 SOUTH ST
PITTSFIELD MA
01201-6803
US

V. Phone/Fax

Practice location:
  • Phone: 413-443-4826
  • Fax:
Mailing address:
  • Phone: 413-443-4826
  • Fax: 413-443-4488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA7114
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: