Provider Demographics
NPI:1386799245
Name:CHICK, CHARLENE ELIZABETH (DO)
Entity type:Individual
Prefix:DR
First Name:CHARLENE
Middle Name:ELIZABETH
Last Name:CHICK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 S SPORTING HILL RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-3058
Mailing Address - Country:US
Mailing Address - Phone:717-697-1645
Mailing Address - Fax:
Practice Address - Street 1:105 S SPORTING HILL RD
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-3058
Practice Address - Country:US
Practice Address - Phone:717-697-1645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB084197207Q00000X
PAOS014421207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0416991Medicaid
NJ0416991Medicaid