Provider Demographics
NPI:1851515902
Name:DEJ MED PRACTICE, LLC
Entity Type:Organization
Organization Name:DEJ MED PRACTICE, LLC
Other - Org Name:PARTNERS IN PEDIATRICS AND FAMILY HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHUKUEMEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:OBIDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-791-7060
Mailing Address - Street 1:303 MEMORIAL BLVD W
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-6219
Mailing Address - Country:US
Mailing Address - Phone:301-791-7060
Mailing Address - Fax:301-791-8990
Practice Address - Street 1:303 MEMORIAL BLVD W
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-6219
Practice Address - Country:US
Practice Address - Phone:301-791-7060
Practice Address - Fax:301-791-8990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDE57291Medicare UPIN