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NPI Code Detail

MEDICARE: JOHN O DEJORDY MD

MEDICARE:   JOHN O DEJORDY  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
1207N00000XDermatology Physician2016181NY

General Provider Information

NPI Number : 1427027549
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN O DEJORDY MD
Provider Business Mailing Address
First Line : 1753 ROUTE 3
Second Line : ADIRONDACK DERMATOLOGY PC
City : MORRISONVILLE
State : NY
Zip : 12962
Country : US
Telephone Number : 518-563-7546
Fax Number : 518-562-5458
Provider Business Practice Location Address
First Line : 1753 ROUTE 3
Second Line : ADIRONDACK DERMATOLOGY PC
City : MORRISONVILLE
State : NY
Zip : 12962
Country : US
Telephone Number : 518-563-7546
Fax Number : 518-562-5458
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2006
Last Update Date : 03/21/2024

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