Healthcare Provider Details

I. General information

NPI: 1437393782
Provider Name (Legal Business Name): JULIE FONTAINE CAPKO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JULIE FONTAINE ROWELL MD

II. Dates (important events)

Enumeration Date: 04/29/2009
Last Update Date: 02/28/2023
Certification Date: 02/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 LOCH RAVEN BLVD
BALTIMORE MD
21239-2945
US

IV. Provider business mailing address

5601 LOCH RAVEN BLVD
BALTIMORE MD
21239-2945
US

V. Phone/Fax

Practice location:
  • Phone: 443-444-4040
  • Fax:
Mailing address:
  • Phone: 443-444-4040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberD73618
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: