Provider Demographics
NPI:1336111822
Name:PEPE, DEANNA A (DO)
Entity Type:Individual
Prefix:DR
First Name:DEANNA
Middle Name:A
Last Name:PEPE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 TIMBERLINE DR
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-3400
Mailing Address - Country:US
Mailing Address - Phone:609-315-2770
Mailing Address - Fax:
Practice Address - Street 1:5000 SAGEMORE DR STE 205
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-4332
Practice Address - Country:US
Practice Address - Phone:856-983-3866
Practice Address - Fax:856-985-8148
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS0139192084P0800X
NJMB071736002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0006726Medicaid
NJ077750A0YMedicare ID - Type Unspecified
NJI03687Medicare UPIN