Provider Demographics
NPI:1891850343
Name:GADENNE, ANNE-SOPHIE J (MD)
Entity Type:Individual
Prefix:
First Name:ANNE-SOPHIE
Middle Name:J
Last Name:GADENNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:345 COURT ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-4329
Mailing Address - Country:US
Mailing Address - Phone:508-746-5300
Mailing Address - Fax:508-747-2001
Practice Address - Street 1:345 COURT ST
Practice Address - Street 2:SUITE 202
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-4329
Practice Address - Country:US
Practice Address - Phone:508-746-5300
Practice Address - Fax:508-747-2001
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA157989207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA070012120OtherRAILROAD MEDICARE
MAJ19552OtherBLUE CROSS
MAJ19552OtherBLUE CROSS
MAA28885Medicare ID - Type Unspecified