Healthcare Provider Details

I. General information

NPI: 1184859571
Provider Name (Legal Business Name): JULIE ANN VERNON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2009
Last Update Date: 05/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 NORTHGATE
AVON CT
06001-4076
US

IV. Provider business mailing address

62 NORTHGATE
AVON CT
06001-4076
US

V. Phone/Fax

Practice location:
  • Phone: 860-675-0542
  • Fax:
Mailing address:
  • Phone: 860-675-0542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number033571
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: