MEDICARE: MISS JULIE ANN HADDY 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	207RN0300X	Nephrology Physician	21365	WV

General Provider Information

NPI Number	:	1629016647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS JULIE ANN HADDY MD

Provider Business Mailing Address
First Line	:	2345 CHESTERFIELD AVENUE
Second Line	:	STE 301
City	:	CHARLESTON
State	:	WV
Zip	:	25304
Country	:	US
Telephone Number	:	304-344-2900
Fax Number	:	304-344-9385

Provider Business Practice Location Address
First Line	:	401 DIVISION ST STE 302
Second Line	:
City	:	SOUTH CHARLESTON
State	:	WV
Zip	:	25309-1455
Country	:	US
Telephone Number	:	304-767-7810
Fax Number	:	304-767-7819

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

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	03/13/2023

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