Healthcare Provider Details

I. General information

NPI: 1629395595
Provider Name (Legal Business Name): DEANA MARIE GIFFORD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2010
Last Update Date: 12/08/2022
Certification Date: 12/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BOWMAN DR
VOORHEES NJ
08043-9612
US

IV. Provider business mailing address

13 S LAKEVIEW DR
GIBBSBORO NJ
08026-1155
US

V. Phone/Fax

Practice location:
  • Phone: 856-247-3921
  • Fax:
Mailing address:
  • Phone: 856-783-2802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC7-0004487
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA09256800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: