MEDICARE: MRS. SAMANTHA MARIA CHASE PA-C

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	363AS0400X	Surgical Physician Assistant	MA061363	PA
2	363A00000X	Physician Assistant	MA061363	PA

General Provider Information

NPI Number	:	1750859625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SAMANTHA MARIA CHASE PA-C

Provider Business Mailing Address
First Line	:	3803 W CHESTER PIKE STE 160
Second Line	:
City	:	NEWTOWN SQUARE
State	:	PA
Zip	:	19073-2336
Country	:	US
Telephone Number	:	484-476-1000
Fax Number	:	484-476-9000

Provider Business Practice Location Address
First Line	:	100 E LANCASTER AVE
Second Line	:	THE HEART PAVILION, MEZZANINE LEVEL
City	:	WYNNEWOOD
State	:	PA
Zip	:	19096-3450
Country	:	US
Telephone Number	:	484-476-1000
Fax Number	:	484-476-9000

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

Provider Enumeration Date	:	11/08/2018
Last Update Date	:	01/09/2026

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