Basic Information
| Provider Information | |||||||||
| NPI: | 1265409437 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GADMACK | ||||||||
| FirstName: | GLORIA | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20525 CENTER RIDGE RD | ||||||||
| Address2: | STE 220 | ||||||||
| City: | ROCKY RIVER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4408955056 | ||||||||
| FaxNumber: | 4403332935 | ||||||||
| Practice Location | |||||||||
| Address1: | 1730 W 25TH ST | ||||||||
| Address2: | MAIN FLOOR | ||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441133108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2163632353 | ||||||||
| FaxNumber: | 2166967375 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2006 | ||||||||
| LastUpdateDate: | 05/27/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 34004740G | OH | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 0403435 | 01 | UNITED HEALTHCARE | OTHER | 0636226 | 01 | AETNA | OTHER | 080164016 | 01 | RR MEDICARE INDIVIDUAL | OTHER | 341783789070 | 01 | CARESOURCE | OTHER | D368301 | 01 | GROUP IND DIAGNOSTICS MED | OTHER | 000000184301 | 01 | ANTHEM | OTHER | F55474 | 01 | SUMMACARE APEX | OTHER | 1780634279 | 01 | GROUP NPI | OTHER | 3610861 | 01 | GROUP ASC MEDICARE | OTHER | 10791744 | 01 | CAQH | OTHER | 0119204 | 01 | GROUP MEDICAID | OTHER | 0799711 | 05 | OH | MEDICAID | 112731 | 01 | KAISER | OTHER | 9273172 | 01 | GROUP MEDICARE | OTHER | CA4511 | 01 | RR MEDICARE GROUP | OTHER |