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General NPI Number Information
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NPI Number | 1972923985
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Entity Type | Individual
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Provider Name | JULIANA H. J. MORTENSON M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/17/2014
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Last Update Date | 04/17/2014
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Provider Practice Location Address
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Address Line | 420 W CRAIGHILL CHANNEL DR
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City | PERRYVILLE
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State | MD
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Zip | 21903-2523
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Country | US
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Telephone | 443-309-3126
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 310
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City | NORTH EAST
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State | MD
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Zip | 21901-0310
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Country | US
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Telephone | 443-309-3126
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | D67643
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License Number State | MD
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