Healthcare Provider Details

I. General information

NPI: 1386848190
Provider Name (Legal Business Name): JULIE A BRAGA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIE A BETTENCOURT MD

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 08/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR DHMC DEPARTMENT OF OBSTETRICS AND GYNECOLOGY
LEBANON NH
03756-1000
US

IV. Provider business mailing address

1 MEDICAL CENTER DR DHMC DEPARTMENT OF OBSTETRICS AND GYNECOLOGY
LEBANON NH
03756-1000
US

V. Phone/Fax

Practice location:
  • Phone: 603-653-9302
  • Fax:
Mailing address:
  • Phone: 603-653-9302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number14448
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: