Provider Demographics
NPI:1740276153
Name:DEJONCKHEERE, JOSEPH P (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:P
Last Name:DEJONCKHEERE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:99 BUSS RD
Mailing Address - Street 2:LOWER
Mailing Address - City:ALIQUIPPA
Mailing Address - State:PA
Mailing Address - Zip Code:15001-4749
Mailing Address - Country:US
Mailing Address - Phone:724-891-5044
Mailing Address - Fax:724-891-5049
Practice Address - Street 1:99 BUSS RD
Practice Address - Street 2:LOWER
Practice Address - City:ALIQUIPPA
Practice Address - State:PA
Practice Address - Zip Code:15001-4749
Practice Address - Country:US
Practice Address - Phone:724-891-5044
Practice Address - Fax:724-891-5049
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2017-05-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD419171207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1012875750001Medicaid
PA1012875750001Medicaid
PA1012875750001Medicaid