Provider Demographics
NPI:1942216676
Name:DEJOSEPH, DEBRA ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:ANNE
Last Name:DEJOSEPH
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 1:1611 S GREEN RD
Mailing Address - Street 2:SUITE 065
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-4128
Mailing Address - Country:US
Mailing Address - Phone:216-291-9171
Mailing Address - Fax:216-291-1827
Practice Address - Street 1:1611 S GREEN RD
Practice Address - Street 2:SUITE 065
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121-4128
Practice Address - Country:US
Practice Address - Phone:216-291-9171
Practice Address - Fax:216-291-1827
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35063951207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0932307Medicaid
OH0932307Medicaid
OHDE0763191Medicare ID - Type Unspecified