Provider Demographics
NPI:1528224615
Name:GADEA, JUAN
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:
Last Name:GADEA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 W CHESTNUT HILL RD STE 6
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2210
Mailing Address - Country:US
Mailing Address - Phone:302-731-5713
Mailing Address - Fax:
Practice Address - Street 1:179 W CHESTNUT HILL RD STE 6
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2210
Practice Address - Country:US
Practice Address - Phone:302-731-5713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-29
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0T00212208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics