Provider Demographics
NPI:1770510430
Name:LADHA, GWENDOLINE LILIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:GWENDOLINE
Middle Name:LILIAN
Last Name:LADHA
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 1:19198 N 95TH PL
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-5572
Mailing Address - Country:US
Mailing Address - Phone:480-538-8178
Mailing Address - Fax:
Practice Address - Street 1:19198 N 95TH PL
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-5572
Practice Address - Country:US
Practice Address - Phone:480-258-0657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ16768207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z140339Medicare PIN