Healthcare Provider Details

I. General information

NPI: 1720471352
Provider Name (Legal Business Name): JULIE LE GIORDANI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2015
Last Update Date: 12/29/2021
Certification Date: 12/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 ENDICOTT ST STE 100
DANVERS MA
01923-0009
US

IV. Provider business mailing address

198 MASSACHUSETTS AVE
NORTH ANDOVER MA
01845-4143
US

V. Phone/Fax

Practice location:
  • Phone: 978-745-6601
  • Fax:
Mailing address:
  • Phone: 978-685-7550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA5275
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: