Healthcare Provider Details

I. General information

NPI: 1780665075
Provider Name (Legal Business Name): CHAD SCOTT HENDRICKSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 07/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 INNOVATION DR SUITE 103 BHS DERMATOLOGY ASSOCIATES CHAD HENDRICKSONMD
SLIPPERY ROCK PA
16057-2468
US

IV. Provider business mailing address

100 INNOVATION DR SUITE 103 BHS DERMATOLOGY ASSOCIATES CHAD HENDRICKSONMD
SLIPPERY ROCK PA
16057-2468
US

V. Phone/Fax

Practice location:
  • Phone: 724-794-7923
  • Fax: 724-794-7931
Mailing address:
  • Phone: 724-794-7923
  • Fax: 724-794-7931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD447706
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: