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Provider Information for 1700080421

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

DR. JOCELYN RAE IDEMA D.O

Gender: FEMALE

Individual NPI: 1700080421

Calendar   Last Updated:  2021-10-19
  Certification Date:  2021-10-19

Details

Name Value
NPI 1700080421
Enumeration Date 2007-06-14
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 480 JOHNSON RD STE 320
WASHINGTON, PA 15301-8936
United States

Phone: 412-206-6770 | Fax: 724-941-5027
View Map External Link
Primary Practice Address 480 JOHNSON RD STE 320
WASHINGTON, PA 15301-8936
United States

Phone: 412-206-6770 | Fax: 724-941-5027
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 207X00000X - Orthopaedic Surgery PA OT012308
No 207X00000X - Orthopaedic Surgery VA 0102202966
No 207X00000X - Orthopaedic Surgery AZ 005444