=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114501939
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JULIA JENNIFER SHAMIS MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/07/2021
-----------------------------------------------------
Last Update Date | 03/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 COOPER PLZ
-----------------------------------------------------
City | CAMDEN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08103-1461
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-826-6737
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24 PURDUE DR
-----------------------------------------------------
City | RICHBORO
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18954-1246
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-360-5045
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | C1-0026837
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------