Healthcare Provider Details

I. General information

NPI: 1013009042
Provider Name (Legal Business Name): JANE TAYLOR GAEDE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 FULTON ST SECTION 113
DURHAM NC
27705-3875
US

IV. Provider business mailing address

PO BOX 747
HILLSBOROUGH NC
27278-0747
US

V. Phone/Fax

Practice location:
  • Phone: 919-286-6925
  • Fax: 919-286-6818
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number15069
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: