Provider Demographics
NPI:1306846589
Name:DEJOYA, GERMAN DY (MD)
Entity Type:Individual
Prefix:DR
First Name:GERMAN
Middle Name:DY
Last Name:DEJOYA
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 1:3024 NEW BERN AVENUE
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610
Mailing Address - Country:US
Mailing Address - Phone:919-350-7270
Mailing Address - Fax:919-350-7204
Practice Address - Street 1:3024 NEW BERN AVENUE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-0000
Practice Address - Country:US
Practice Address - Phone:919-350-7270
Practice Address - Fax:919-350-7204
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD055492L207R00000X
NC2008-00611207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02213596OtherNY MEDICAL ASSISTANCE
PA0018741920001Medicaid
NY00025817201OtherUNIVERA
PA124571OtherUNISON
PA1521461OtherGATEWAY
PA2109107OtherAETNA
PA110241542OtherRR MEDICARE
PA400014OtherUPMC
PA193623OtherBLUE SHIELD
OH2282882OtherOH MEDICAL ASSISTANCE
WV1047850OtherWEST VIRGINIA WORK COMP
NY02213596OtherNY MEDICAL ASSISTANCE
PA193623OtherBLUE SHIELD