Individual
GRACIA DE JONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
55 CLAIREDAN DR, POWELL, OH 43065-8064
(614) 888-8989
(614) 888-8968
Mailing address
55 CLAIREDAN DR, POWELL, OH 43065-8064
(614) 888-8989
(614) 888-8968
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
35.141481
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0435440
—
OH
01
—
H771400
CGS MEDICARE
OH
Enumeration date
04/01/2018
Last updated
01/11/2023
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