Provider Demographics
NPI:1548455363
Name:DEJOHN, MATTHEW (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:DEJOHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4226 SASSAFRAS ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-3053
Mailing Address - Country:US
Mailing Address - Phone:814-440-6867
Mailing Address - Fax:814-240-6890
Practice Address - Street 1:1611 PEACH ST STE 105
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16501-2120
Practice Address - Country:US
Practice Address - Phone:814-823-5640
Practice Address - Fax:814-240-6890
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-14
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD4325412084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry