Healthcare Provider Details

I. General information

NPI: 1538428479
Provider Name (Legal Business Name): KARA FORDYCE GADOMSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KARA EILEEN FORDYCE

II. Dates (important events)

Enumeration Date: 05/13/2012
Last Update Date: 05/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 OGLETOWN STANTON RD LE15 CHRISTIANA HOSPITAL
NEWARK DE
19718-0001
US

IV. Provider business mailing address

4755 OGLETOWN STANTON RD LE15 CHRISTIANA HOSPITAL
NEWARK DE
19718-0001
US

V. Phone/Fax

Practice location:
  • Phone: 302-733-6364
  • Fax:
Mailing address:
  • Phone: 302-733-6364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberPI113153
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: