Healthcare Provider Details

I. General information

NPI: 1336408947
Provider Name (Legal Business Name): JOSEPH ANDREW DEKKER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2012
Last Update Date: 06/16/2020
Certification Date: 06/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 BALTIMORE ST
CUMBERLAND MD
21502-2472
US

IV. Provider business mailing address

2269 BRIMSTONE PL
HANOVER MD
21076-1871
US

V. Phone/Fax

Practice location:
  • Phone: 301-722-3215
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberH0075809
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberOS019371
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0102205761
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code2081N0008X
TaxonomyNeuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
License Number15525
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: