Provider Demographics
NPI:1285682856
Name:DEROSA, JULIE K (MD)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:K
Last Name:DEROSA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 746722
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6722
Mailing Address - Country:US
Mailing Address - Phone:773-352-1515
Mailing Address - Fax:312-929-0373
Practice Address - Street 1:2311 COTTMAN AVE STE 71
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-1007
Practice Address - Country:US
Practice Address - Phone:215-444-7505
Practice Address - Fax:215-695-2919
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2025-02-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD051117L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015888700004Medicaid
PA0000877811Medicare UPIN
PA0015888700004Medicaid