Provider Demographics
NPI:1215314356
Name:DEKIS, JOANNE (MD)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:DEKIS
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 1:3023 HAMAKER CT STE 500
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-2241
Mailing Address - Country:US
Mailing Address - Phone:703-876-2788
Mailing Address - Fax:571-776-3190
Practice Address - Street 1:3023 HAMAKER CT STE 500
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2241
Practice Address - Country:US
Practice Address - Phone:703-876-2788
Practice Address - Fax:571-776-3190
Is Sole Proprietor?:No
Enumeration Date:2015-04-27
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101276508208000000X, 207X00000X
CAA168951208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No208000000XAllopathic & Osteopathic PhysiciansPediatrics