MEDICARE: DR. JULIE ANN AMBROSE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	0101242818	VA

General Provider Information

NPI Number	:	1043263163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIE ANN AMBROSE M.D.

Provider Business Mailing Address
First Line	:	2101 E JEFFERSON ST
Second Line	:	KAISER PERMANENTE MEDICARE ENROLLMENT
City	:	ROCKVILLE
State	:	MD
Zip	:	20852-4908
Country	:	US
Telephone Number	:	301-816-2424
Fax Number	:	703-237-1400

Provider Business Practice Location Address
First Line	:	8008 WESTPARK DR
Second Line	:
City	:	MC LEAN
State	:	VA
Zip	:	22102-3109
Country	:	US
Telephone Number	:	703-287-4550
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	06/22/2021

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