Provider Demographics
NPI:1780768804
Name:HADGU, PIETROS (MD)
Entity type:Individual
Prefix:DR
First Name:PIETROS
Middle Name:
Last Name:HADGU
Suffix:
Gender:M
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:NEMOURS CHILDRENS CLINIC
Mailing Address - Street 2:P.O. BOX 404112
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-0001
Mailing Address - Country:US
Mailing Address - Phone:904-390-3610
Mailing Address - Fax:904-288-5890
Practice Address - Street 1:ATLANTICARE REGIONAL MEDICAL CENTER
Practice Address - Street 2:JIMMIE LEEDS ROAD
Practice Address - City:POMONA
Practice Address - State:NJ
Practice Address - Zip Code:08240-9104
Practice Address - Country:US
Practice Address - Phone:609-652-1000
Practice Address - Fax:609-404-3818
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA036927002080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1659927Medicaid
NJ174700Medicaid
MD63053Medicaid
SCQ92700Medicaid
MD63053Medicaid
NJ174700Medicaid