Provider Demographics
NPI:1538556386
Name:GALLIMORE, JADE PALAZZOLA (DO)
Entity type:Individual
Prefix:DR
First Name:JADE
Middle Name:PALAZZOLA
Last Name:GALLIMORE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MISS
Other - First Name:JADE
Other - Middle Name:KRISTIN
Other - Last Name:PALAZZOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3100 MACCORKLE AVE SE STE 700
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1230
Mailing Address - Country:US
Mailing Address - Phone:304-556-3810
Mailing Address - Fax:
Practice Address - Street 1:3100 MACCORKLE AVE SE STE 700
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1230
Practice Address - Country:US
Practice Address - Phone:304-556-3810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-20
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3829208600000X
WV04653208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery