Provider Demographics
NPI:1750393633
Name:HADLEY, PATRICIA (MD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:HADLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:HANSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 492080
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96049-2080
Mailing Address - Country:US
Mailing Address - Phone:530-241-0473
Mailing Address - Fax:530-229-3703
Practice Address - Street 1:2020 COURT ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1822
Practice Address - Country:US
Practice Address - Phone:530-243-1236
Practice Address - Fax:530-243-8502
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG734172085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G734172Medicaid
CA00G734170Medicare ID - Type Unspecified
CA00G734172Medicaid