Healthcare Provider Details

I. General information

NPI: 1184621112
Provider Name (Legal Business Name): DEJIE JOHN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEJIE JOSEPH MD

II. Dates (important events)

Enumeration Date: 07/06/2005
Last Update Date: 07/31/2023
Certification Date: 03/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 OYSTER POINT RD STE 200
NEWPORT NEWS VA
23606-4570
US

IV. Provider business mailing address

811 REDGATE AVE
NORFOLK VA
23507-1515
US

V. Phone/Fax

Practice location:
  • Phone: 757-668-4851
  • Fax: 757-668-4847
Mailing address:
  • Phone: 757-668-7007
  • Fax: 757-668-8658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number36552
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number201301925
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101277377
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: