Provider Demographics
NPI:1629395595
Name:GIFFORD, DEANA MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:DEANA
Middle Name:MARIE
Last Name:GIFFORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 S LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:GIBBSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08026-1155
Mailing Address - Country:US
Mailing Address - Phone:856-783-2802
Mailing Address - Fax:
Practice Address - Street 1:100 BOWMAN DR
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-9612
Practice Address - Country:US
Practice Address - Phone:856-247-3921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-30
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC7-0004487208000000X
390200000X
NJ25MA09256800208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program