Provider Demographics
NPI:1689866204
Name:DAVIDSON, JEAN MARIE (DO)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:MARIE
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:301 LIPPINCOTT DR STE 410
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4197
Mailing Address - Country:US
Mailing Address - Phone:856-355-0340
Mailing Address - Fax:856-355-0330
Practice Address - Street 1:200 BOWMAN DR
Practice Address - Street 2:SUITE E385
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043
Practice Address - Country:US
Practice Address - Phone:856-673-3490
Practice Address - Fax:856-795-1475
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB08118200207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0311863Medicaid
NJ0311863Medicaid