Provider Demographics
NPI:1386622447
Name:MCCLEARY., CHASTITY LYNN-WILKINSON (DO)
Entity type:Individual
Prefix:DR
First Name:CHASTITY
Middle Name:LYNN-WILKINSON
Last Name:MCCLEARY.
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:CHASTITY
Other - Middle Name:LYNN
Other - Last Name:WILKINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:2188 SANDY DR.
Mailing Address - Street 2:SUITE A
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803
Mailing Address - Country:US
Mailing Address - Phone:814-278-1977
Mailing Address - Fax:814-272-0070
Practice Address - Street 1:2188 SANDY DR.
Practice Address - Street 2:SUITE A.
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803
Practice Address - Country:US
Practice Address - Phone:814-278-1977
Practice Address - Fax:814-272-0070
Is Sole Proprietor?:No
Enumeration Date:2006-01-08
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS013092207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I13725Medicare UPIN