Provider Demographics
NPI:1538428479
Name:GADOMSKI, KARA FORDYCE
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:FORDYCE
Last Name:GADOMSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KARA
Other - Middle Name:EILEEN
Other - Last Name:FORDYCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4755 OGLETOWN STANTON RD
Mailing Address - Street 2:LE15 CHRISTIANA HOSPITAL
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19718-0001
Mailing Address - Country:US
Mailing Address - Phone:302-733-6364
Mailing Address - Fax:
Practice Address - Street 1:4755 OGLETOWN STANTON RD
Practice Address - Street 2:LE15 CHRISTIANA HOSPITAL
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19718-0001
Practice Address - Country:US
Practice Address - Phone:302-733-6364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-13
Last Update Date:2012-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPI113153390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program