Healthcare Provider Details

I. General information

NPI: 1417151663
Provider Name (Legal Business Name): JULIA M GREENWALD PA-C, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 BIRCH PT
INDIAN PURCHASE TWP ME
04462-6138
US

IV. Provider business mailing address

39 ORCHARD ST
MILLINOCKET ME
04462-1940
US

V. Phone/Fax

Practice location:
  • Phone: 603-724-5146
  • Fax:
Mailing address:
  • Phone: 603-724-5146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA1473
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: