Healthcare Provider Details

I. General information

NPI: 1356545446
Provider Name (Legal Business Name): JULIE HERON HARRELD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 11/12/2020
Certification Date: 11/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE MEDICAL CENTER DR
LEBANON NH
03756-0001
US

IV. Provider business mailing address

ONE MEDICAL CENTER DR
LEBANON NH
03756-0001
US

V. Phone/Fax

Practice location:
  • Phone: 603-650-5922
  • Fax:
Mailing address:
  • Phone: 603-650-4488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License Number46004
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License Number20967
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: