Provider Demographics
NPI:1750311916
Name:DEJTER, STEPHEN WILLIAM JR (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:WILLIAM
Last Name:DEJTER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3301 NEW MEXICO AVE NW STE 311
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-3624
Mailing Address - Country:US
Mailing Address - Phone:202-364-8918
Mailing Address - Fax:202-686-6438
Practice Address - Street 1:3301 NEW MEXICO AVE NW STE 311
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-3624
Practice Address - Country:US
Practice Address - Phone:202-364-3434
Practice Address - Fax:202-686-6382
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2010-12-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
DCMD17767208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCE22124Medicare UPIN
DC461413S96Medicare PIN