MEDICARE: JULIE F OVERHOLTZER 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	207Q00000X	Family Medicine Physician	0101045155	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	286087	OTHER	VA	ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790781474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE F OVERHOLTZER M.D.

Provider Business Mailing Address
First Line	:	PO BOX 37174
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21297-3174
Country	:	US
Telephone Number	:	571-423-5699
Fax Number	:

Provider Business Practice Location Address
First Line	:	6201 CENTREVILLE RD
Second Line	:	STE 100
City	:	CENTREVILLE
State	:	VA
Zip	:	20121-2626
Country	:	US
Telephone Number	:	703-263-9600
Fax Number	:	703-266-1452

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

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	05/23/2023

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