Provider Demographics
NPI:1164805560
Name:OHDE, JANE MARIE (DO)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:MARIE
Last Name:OHDE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:367 S GULPH RD
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-3121
Mailing Address - Country:US
Mailing Address - Phone:775-356-4888
Mailing Address - Fax:775-356-4890
Practice Address - Street 1:2385 E PRATER WAY STE 205
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89434-9688
Practice Address - Country:US
Practice Address - Phone:775-356-4888
Practice Address - Fax:775-356-4890
Is Sole Proprietor?:No
Enumeration Date:2015-07-02
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS020435208600000X
NVDO2988208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
14655950OtherCAQH
NVV70057OtherMEDICARE
PA103774751Medicaid
NV250015420Medicaid