Provider Demographics
NPI:1609843549
Name:HADLEY, RITA M (MD PHD)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:M
Last Name:HADLEY
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2945 S DOBSON RD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-7941
Mailing Address - Country:US
Mailing Address - Phone:480-969-4138
Mailing Address - Fax:480-969-0630
Practice Address - Street 1:2945 S DOBSON RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-7941
Practice Address - Country:US
Practice Address - Phone:480-969-4138
Practice Address - Fax:480-969-0630
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ48671208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ028228Medicaid
OHH120850Medicare PIN
OHA57297Medicare UPIN
OHAN4071991Medicare ID - Type Unspecified