MEDICARE: DEJOHN MEDICAL LABORATORIES, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory	000363	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003813189
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEJOHN MEDICAL LABORATORIES, INC

Provider Business Mailing Address
First Line	:	1570 GARRETT RD
Second Line	:
City	:	UPPER DARBY
State	:	PA
Zip	:	19082-4500
Country	:	US
Telephone Number	:	610-626-2112
Fax Number	:	610-626-5923

Provider Business Practice Location Address
First Line	:	1570 GARRETT RD
Second Line	:
City	:	UPPER DARBY
State	:	PA
Zip	:	19082-4500
Country	:	US
Telephone Number	:	610-626-2112
Fax Number	:	610-626-5923

Authorized Official
Title or Position	:	PRESIDENT/ OWNER
Name	:	MS. JEAN S DEJOHN
Credential	:
Telephone Number	:	610-626-2112

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	08/22/2020

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