MEDICARE: DR. JULIE K DEROSA MD

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	207Q00000X	Family Medicine Physician	MD051117L	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	:	1285682856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIE K DEROSA MD

Provider Business Mailing Address
First Line	:	PO BOX 746722
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-6722
Country	:	US
Telephone Number	:	773-352-1515
Fax Number	:	312-929-0373

Provider Business Practice Location Address
First Line	:	2311 COTTMAN AVE STE 71
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19149-1007
Country	:	US
Telephone Number	:	215-444-7505
Fax Number	:	215-695-2919

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	02/05/2025

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