Healthcare Provider Details

I. General information

NPI: 1003813189
Provider Name (Legal Business Name): DEJOHN MEDICAL LABORATORIES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1570 GARRETT RD
UPPER DARBY PA
19082-4500
US

IV. Provider business mailing address

1570 GARRETT RD
UPPER DARBY PA
19082-4500
US

V. Phone/Fax

Practice location:
  • Phone: 610-626-2112
  • Fax: 610-626-5923
Mailing address:
  • Phone: 610-626-2112
  • Fax: 610-626-5923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number000363
License Number StatePA

VIII. Authorized Official

Name: MS. JEAN S DEJOHN
Title or Position: PRESIDENT/ OWNER
Credential:
Phone: 610-626-2112