MEDICARE: DR. STEPHEN WILLIAM DEJTER JR. M.D.

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	208800000X	Urology Physician	MD17767	DC

General Provider Information

NPI Number	:	1750311916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN WILLIAM DEJTER JR. M.D.

Provider Business Mailing Address
First Line	:	3301 NEW MEXICO AVE NW STE 311
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20016-3624
Country	:	US
Telephone Number	:	202-364-8918
Fax Number	:	202-686-6438

Provider Business Practice Location Address
First Line	:	3301 NEW MEXICO AVE NW STE 311
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20016-3624
Country	:	US
Telephone Number	:	202-364-3434
Fax Number	:	202-686-6382

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

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	12/15/2010

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