Provider Demographics
NPI:1669353504
Name:DEJ MED PRACTICE, LLC
Entity type:Organization
Organization Name:DEJ MED PRACTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHUKWUEMEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:OBIDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-791-7060
Mailing Address - Street 1:303 MEMORIAL BLVD W
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-6219
Mailing Address - Country:US
Mailing Address - Phone:301-791-7060
Mailing Address - Fax:301-791-8990
Practice Address - Street 1:13316 MARSH PIKE
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-2573
Practice Address - Country:US
Practice Address - Phone:301-791-7060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEJ MED PRACTICE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-09-09
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty