Healthcare Provider Details

I. General information

NPI: 1285996074
Provider Name (Legal Business Name): JULIA MICHELLE CULLEN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIA MICHELLE LOIACONO DO

II. Dates (important events)

Enumeration Date: 06/08/2012
Last Update Date: 12/18/2020
Certification Date: 12/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 S STATE ST
DOVER DE
19901-3530
US

IV. Provider business mailing address

640 S. STATE STREET, MAIL CODE 3055
DOVER DE
19901
US

V. Phone/Fax

Practice location:
  • Phone: 302-744-6156
  • Fax: 302-735-3845
Mailing address:
  • Phone: 302-480-1688
  • Fax: 302-480-9807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberC2-0011686
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: