Provider Demographics
NPI:1700080421
Name:IDEMA, JOCELYN RAE (DO)
Entity Type:Individual
Prefix:DR
First Name:JOCELYN
Middle Name:RAE
Last Name:IDEMA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:470 JOHNSON ROAD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-8936
Mailing Address - Country:US
Mailing Address - Phone:412-206-6770
Mailing Address - Fax:724-941-5027
Practice Address - Street 1:470 JOHNSON ROAD
Practice Address - Street 2:SUITE 210
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-8936
Practice Address - Country:US
Practice Address - Phone:412-206-6770
Practice Address - Fax:724-941-5027
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0102202966207X00000X
AZ005444207X00000X
PAOT012308207X00000X
PAOS017370207XS0117X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine