Healthcare Provider Details

I. General information

NPI: 1215314356
Provider Name (Legal Business Name): JOANNE DEKIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2015
Last Update Date: 11/04/2022
Certification Date: 11/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3023 HAMAKER CT STE 500
FAIRFAX VA
22031-2241
US

IV. Provider business mailing address

3023 HAMAKER CT STE 500
FAIRFAX VA
22031-2241
US

V. Phone/Fax

Practice location:
  • Phone: 703-876-2788
  • Fax: 571-776-3190
Mailing address:
  • Phone: 703-876-2788
  • Fax: 571-776-3190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101276508
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA168951
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number0101276508
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: