MEDICARE: DR. JULIE VANILLE VASILE M.D.

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	174400000X	Specialist	220384	NY
2	208200000X	Plastic Surgery Physician	046797	CT

General Provider Information

NPI Number	:	1558425678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIE VANILLE VASILE M.D.

Provider Business Mailing Address
First Line	:	1290 SUMMER ST
Second Line	:	SUITE 3200
City	:	STAMFORD
State	:	CT
Zip	:	06905-5360
Country	:	US
Telephone Number	:	203-965-0656
Fax Number	:	203-965-0646

Provider Business Practice Location Address
First Line	:	1290 SUMMER ST
Second Line	:	SUITE 3200
City	:	STAMFORD
State	:	CT
Zip	:	06905-5360
Country	:	US
Telephone Number	:	203-965-0656
Fax Number	:	203-965-0646

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

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	10/20/2009

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