Provider Demographics
NPI:1144726969
Name:GADOMSKI, ALICIA MARIA (DO)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:MARIA
Last Name:GADOMSKI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8603
Mailing Address - Fax:
Practice Address - Street 1:426 MEMORIAL DRIVE EXT
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29651-1818
Practice Address - Country:US
Practice Address - Phone:864-877-9066
Practice Address - Fax:864-241-9224
Is Sole Proprietor?:No
Enumeration Date:2018-04-02
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2019-02419207Q00000X
SC83576207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine