Healthcare Provider Details

I. General information

NPI: 1417069907
Provider Name (Legal Business Name): JULIA RENEE FREW MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIA RENEE HERMANN

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR DEPARTMENT OF PSYCHIATRY
LEBANON NH
03756-1000
US

IV. Provider business mailing address

1 MEDICAL CENTER DR DEPARTMENT OF PSYCHIATRY
LEBANON NH
03756-1000
US

V. Phone/Fax

Practice location:
  • Phone: 603-650-7075
  • Fax: 603-650-9442
Mailing address:
  • Phone: 603-650-7075
  • Fax: 603-650-9442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number14795
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: