Provider Demographics
NPI:1306042387
Name:HADAWAY, GERRY (MS, MAC)
Entity Type:Individual
Prefix:
First Name:GERRY
Middle Name:
Last Name:HADAWAY
Suffix:
Gender:F
Credentials:MS, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35252 HUDSON WAY
Mailing Address - Street 2:UNIT 2
Mailing Address - City:REHOBOTH BEACH
Mailing Address - State:DE
Mailing Address - Zip Code:19971-4419
Mailing Address - Country:US
Mailing Address - Phone:302-644-8944
Mailing Address - Fax:
Practice Address - Street 1:35252 HUDSON WAY
Practice Address - Street 2:UNIT 2
Practice Address - City:REHOBOTH BEACH
Practice Address - State:DE
Practice Address - Zip Code:19971-4419
Practice Address - Country:US
Practice Address - Phone:302-644-8944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU00647171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDU00647OtherMARYLAND STATE BOARD