Provider Demographics
NPI:1861449357
Name:GATEWAY PEDIATRICS PLLC
Entity Type:Organization
Organization Name:GATEWAY PEDIATRICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUDHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANDRASEKHAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-963-6668
Mailing Address - Street 1:655 S DOBSON RD
Mailing Address - Street 2:B218
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-5667
Mailing Address - Country:US
Mailing Address - Phone:480-963-6668
Mailing Address - Fax:480-963-6669
Practice Address - Street 1:655 S DOBSON RD
Practice Address - Street 2:B218
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5667
Practice Address - Country:US
Practice Address - Phone:480-963-6668
Practice Address - Fax:480-963-6669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ649494Medicaid
AZ649494Medicaid