Healthcare Provider Details

I. General information

NPI: 1649615469
Provider Name (Legal Business Name): JULIA THORN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2013
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 FRONT ST
CHICOPEE MA
01013-3140
US

IV. Provider business mailing address

PO BOX 1337
GALLUP NM
87305-1337
US

V. Phone/Fax

Practice location:
  • Phone: 413-420-2222
  • Fax:
Mailing address:
  • Phone: 505-722-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD83212
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: