Provider Demographics
NPI:1467665554
Name:VALDESUSO, GLADYS MARIA (MD)
Entity Type:Individual
Prefix:DR
First Name:GLADYS
Middle Name:MARIA
Last Name:VALDESUSO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 HODGE ROAD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540
Mailing Address - Country:US
Mailing Address - Phone:609-577-0962
Mailing Address - Fax:609-921-2982
Practice Address - Street 1:WASHINGTON ROAD
Practice Address - Street 2:MCCOSH HEALTH CENTER PRINCETON UNIVERSITY
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08544
Practice Address - Country:US
Practice Address - Phone:609-258-1428
Practice Address - Fax:609-258-1355
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05579500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine