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General NPI Number Information
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NPI Number | 1801871959
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Entity Type | Individual
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Provider Name | EWA GADDIS MD
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Gender | Female
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Dates
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Enumeration Date | 12/13/2005
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Last Update Date | 09/20/2013
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Provider Practice Location Address
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Address Line | 224 GREAT BRIDGE BLVD.
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City | CHESAPEAKE
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State | VA
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Zip | 23320
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Country | US
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Telephone | 757-482-7159
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Fax |
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Provider Business Mailing Address
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Address Line | 224 GREAT BRIDGE BLVD.
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City | CHESAPEAKE
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State | VA
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Zip | 23320
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Country | US
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Telephone | 757-482-7159
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD418919
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 0101233125
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License Number State | VA
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