Basic Information
| Provider Information | |||||||||
| NPI: | 1659747483 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STRATFORD | ||||||||
| FirstName: | CHAD | ||||||||
| MiddleName: | VAL | ||||||||
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| Credential: | PA-C, DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 232 W 25TH ST | ||||||||
| Address2: | |||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165440001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144525000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 252 W 25TH ST | ||||||||
| Address2: | |||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 16544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144525000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2015 | ||||||||
| LastUpdateDate: | 06/20/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | MA057622 | PA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363AM0700X | 50.006022 | OH | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 207P00000X | OT019441 | PA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.