Provider Demographics
NPI:1063625176
Name:GADEGBEKU, ANNETTE (MD)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:GADEGBEKU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 CHERRY ST
Mailing Address - Street 2:SUITE 11511
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-1320
Mailing Address - Country:US
Mailing Address - Phone:215-255-7822
Mailing Address - Fax:215-255-7825
Practice Address - Street 1:833 CHESTNUT ST
Practice Address - Street 2:SUITE 301
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4414
Practice Address - Country:US
Practice Address - Phone:215-955-7190
Practice Address - Fax:215-923-9186
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2016-05-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD430494207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine