Provider Demographics
NPI:1679776926
Name:DEJOSEPH, JULIA L (MD)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:L
Last Name:DEJOSEPH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:E
Other - Last Name:LOU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1412-22 FAIRMOUNT AVENUE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130
Mailing Address - Country:US
Mailing Address - Phone:215-235-9600
Mailing Address - Fax:215-232-4093
Practice Address - Street 1:401 W ALLEGHENY AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19133-3644
Practice Address - Country:US
Practice Address - Phone:215-291-2500
Practice Address - Fax:215-291-2502
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD438550207Q00000X
MA243186207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1029176530001Medicaid
MA1747201Medicare PIN
MA1679776926Medicare UPIN
PA354994YZFTMedicare PIN