MEDICARE: JOSEPH P DEJONCKHEERE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	MD419171	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740276153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH P DEJONCKHEERE MD

Provider Business Mailing Address
First Line	:	99 BUSS RD
Second Line	:	LOWER
City	:	ALIQUIPPA
State	:	PA
Zip	:	15001-4749
Country	:	US
Telephone Number	:	724-891-5044
Fax Number	:	724-891-5049

Provider Business Practice Location Address
First Line	:	99 BUSS RD
Second Line	:	LOWER
City	:	ALIQUIPPA
State	:	PA
Zip	:	15001-4749
Country	:	US
Telephone Number	:	724-891-5044
Fax Number	:	724-891-5049

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2005
Last Update Date	:	05/09/2017

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