Provider Demographics
NPI:1710976139
Name:JUAN P GADEA MD PA
Entity Type:Organization
Organization Name:JUAN P GADEA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:GADEA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-731-0858
Mailing Address - Street 1:179 W CHESTNUT HILL RD
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:302-731-0858
Mailing Address - Fax:302-731-0027
Practice Address - Street 1:179 W CHESTNUT HILL RD
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:302-731-0858
Practice Address - Fax:302-731-0027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-18
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10T00212208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D01166Medicare UPIN