Healthcare Provider Details

I. General information

NPI: 1972917524
Provider Name (Legal Business Name): EMILY HEJAZI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2014
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3737 MARKET ST FL 11
PHILADELPHIA PA
19104-5545
US

IV. Provider business mailing address

3600 SPRUCE ST
PHILADELPHIA PA
19104-4211
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-8060
  • Fax: 215-243-3284
Mailing address:
  • Phone: 215-662-2737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD482170
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: