Provider Demographics
NPI:1699703694
Name:LAUER, CHAD
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:LAUER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3742 STATE ROUTE 257
Mailing Address - Street 2:SUITE D
Mailing Address - City:SENECA
Mailing Address - State:PA
Mailing Address - Zip Code:16346-3318
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3742 STATE ROUTE 257
Practice Address - Street 2:SUITE D
Practice Address - City:SENECA
Practice Address - State:PA
Practice Address - Zip Code:16346-3318
Practice Address - Country:US
Practice Address - Phone:814-678-3343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007530363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1010793940001Medicaid
PA068393QUTMedicare ID - Type Unspecified