MEDICARE: DR. GERMAN DY DEJOYA 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	207R00000X	Internal Medicine Physician	MD055492L	PA
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	2008-00611	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
7	110241542	OTHER	PA	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	02213596	OTHER	NY	NY MEDICAL ASSISTANCE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	00025817201	OTHER	NY	UNIVERA
4	124571	OTHER	PA	UNISON
5	1521461	OTHER	PA	GATEWAY
6	2109107	OTHER	PA	AETNA
8	400014	OTHER	PA	UPMC
9	193623	OTHER	PA	BLUE SHIELD
10	2282882	OTHER	OH	OH MEDICAL ASSISTANCE
11	1047850	OTHER	WV	WEST VIRGINIA WORK COMP

General Provider Information

NPI Number	:	1306846589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GERMAN DY DEJOYA MD

Provider Business Mailing Address
First Line	:	3024 NEW BERN AVENUE
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610
Country	:	US
Telephone Number	:	919-350-7270
Fax Number	:	919-350-7204

Provider Business Practice Location Address
First Line	:	3024 NEW BERN AVENUE
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610-0000
Country	:	US
Telephone Number	:	919-350-7270
Fax Number	:	919-350-7204

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

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	11/30/2015

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