Healthcare Provider Details

I. General information

NPI: 1720009467
Provider Name (Legal Business Name): JULIE FORTNER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIE WEAVER MD

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10571 TELEGRAPH RD SUITE 110
GLEN ALLEN VA
23059-4652
US

IV. Provider business mailing address

10571 TELEGRAPH RD SUITE 110
GLEN ALLEN VA
23059-4652
US

V. Phone/Fax

Practice location:
  • Phone: 804-266-9616
  • Fax: 804-261-4935
Mailing address:
  • Phone: 804-266-9616
  • Fax: 804-261-4935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: