Basic Information
| Provider Information | |||||||||
| NPI: | 1780768804 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HADGU | ||||||||
| FirstName: | PIETROS | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | NEMOURS CHILDRENS CLINIC | ||||||||
| Address2: | P.O. BOX 404112 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303840001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043903610 | ||||||||
| FaxNumber: | 9042885890 | ||||||||
| Practice Location | |||||||||
| Address1: | ATLANTICARE REGIONAL MEDICAL CENTER | ||||||||
| Address2: | JIMMIE LEEDS ROAD | ||||||||
| City: | POMONA | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082409104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6096521000 | ||||||||
| FaxNumber: | 6094043818 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2006 | ||||||||
| LastUpdateDate: | 05/16/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080N0001X | MA03692700 | NJ | Y | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1659927 | 05 | PA | MEDICAID | 174700 | 05 | NJ | MEDICAID | 63053 | 05 | MD | MEDICAID | Q92700 | 05 | SC | MEDICAID |