MEDICARE: DR. JUEL R. NALL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	MD070387L	PA
2	2084P0800X	Psychiatry Physician	MD070387L	PA

General Provider Information

NPI Number	:	1033244850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUEL R. NALL MD

Provider Business Mailing Address
First Line	:	5044 SPRUCE ST
Second Line	:	MEDNET HEALTHCARE SYSTEMS
City	:	PHILADELPHIA
State	:	PA
Zip	:	19139-4115
Country	:	US
Telephone Number	:	215-474-4410
Fax Number	:	215-474-4418

Provider Business Practice Location Address
First Line	:	5044 SPRUCE ST
Second Line	:	MEDNET HEALTHCARE SYSTEMS
City	:	PHILADELPHIA
State	:	PA
Zip	:	19139-4115
Country	:	US
Telephone Number	:	215-474-4410
Fax Number	:	215-474-4410

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	04/26/2011

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