Healthcare Provider Details

I. General information

NPI: 1306709126
Provider Name (Legal Business Name): HENDRICKSON CLINICAL INNOVATIONS GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 W FAIRMONT AVE
NEW CASTLE PA
16105-1909
US

IV. Provider business mailing address

36 BRIARWOOD LN
NEW WILMINGTON PA
16142-1938
US

V. Phone/Fax

Practice location:
  • Phone: 833-604-7212
  • Fax:
Mailing address:
  • Phone: 724-730-8382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: CHAD SCOTT HENDRICKSON
Title or Position: OWNER
Credential: MD
Phone: 724-730-8382