Provider Demographics
NPI:1790722981
Name:JIH, DEBRA (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:
Last Name:JIH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2512 DELANCEY ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-6457
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:822 PINE ST STE 2A
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-6187
Practice Address - Country:US
Practice Address - Phone:267-519-0154
Practice Address - Fax:267-519-0597
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD402760207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1466044OtherPENNSYLVANIA BLUE SHIELD
PA2150309000OtherINDEPENDENCE BLUE CROSS
PA7772455OtherAETNA HEALTHPLANS
PA2150309000OtherINDEPENDENCE BLUE CROSS