Provider Demographics
NPI:1518227578
Name:GRAY, JADE MARIE (DPM)
Entity type:Individual
Prefix:
First Name:JADE
Middle Name:MARIE
Last Name:GRAY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:JADE
Other - Middle Name:MARIE
Other - Last Name:BARNARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:406 HAZELWOOD LANE
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053
Mailing Address - Country:US
Mailing Address - Phone:856-780-0779
Mailing Address - Fax:
Practice Address - Street 1:406 HAZELWOOD LANE
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053
Practice Address - Country:US
Practice Address - Phone:856-780-0779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-24
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00313200213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist