Provider Demographics
NPI:1154492502
Name:DEREN, JULIUS J (MD)
Entity Type:Individual
Prefix:
First Name:JULIUS
Middle Name:J
Last Name:DEREN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 SPRUCE ST
Mailing Address - Street 2:3 DULLES BUILDING
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4206
Mailing Address - Country:US
Mailing Address - Phone:215-349-8222
Mailing Address - Fax:215-662-0950
Practice Address - Street 1:3400 SPRUCE ST
Practice Address - Street 2:3 DULLES BUILDING
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4206
Practice Address - Country:US
Practice Address - Phone:215-349-8222
Practice Address - Fax:215-662-0950
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD010674E207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000740004Medicaid
PAC27538Medicare UPIN
PA018863Medicare ID - Type Unspecified