Doctor Name: | JULIANA H. J. MORTENSON |
NPI Number: | 1972923985 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.D. |
License Number: | D67643 |
Business Practice Address: | 420 W Craighill Channel Dr Perryville, MD - 219032523 |
Business Phone Number: | 4433093126 |
Business Fax Number: | |
Mailing Address: | Po Box 310, NORTH EAST |
State: | MD |
Postal Code: | 219010310 |
Phone Number: | 4433093126 |
Fax Number: | |
NPI Enumeration Date: | 04/17/2014 |
NPI Last Update Date: | 04/17/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | D67643 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MD |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |