Healthcare Provider Details

I. General information

NPI: 1710976139
Provider Name (Legal Business Name): JUAN P GADEA MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 01/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

179 W CHESTNUT HILL RD
NEWARK DE
19713-2210
US

IV. Provider business mailing address

179 W CHESTNUT HILL RD
NEWARK DE
19713-2210
US

V. Phone/Fax

Practice location:
  • Phone: 302-731-0858
  • Fax: 302-731-0027
Mailing address:
  • Phone: 302-731-0858
  • Fax: 302-731-0027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC10T00212
License Number StateDE

VIII. Authorized Official

Name: JUAN R GADEA
Title or Position: PRESIDENT
Credential: MD
Phone: 302-731-0858