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General NPI Number Information
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NPI Number | 1548455363
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Entity Type | Individual
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Provider Name | MATTHEW DEJOHN M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/14/2007
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Last Update Date | 04/07/2020
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Provider Practice Location Address
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Address Line | 1611 PEACH ST STE 105
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City | ERIE
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State | PA
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Zip | 16501-2120
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Country | US
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Telephone | 814-823-5640
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Fax | 814-240-6890
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Provider Business Mailing Address
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Address Line | 4226 SASSAFRAS ST
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City | ERIE
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State | PA
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Zip | 16508-3053
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Country | US
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Telephone | 814-440-6867
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Fax | 814-240-6890
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD432541
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License Number State | PA
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