Provider Demographics
NPI:1679562979
Name:PHELPS, JULIE J (MD)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:J
Last Name:PHELPS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 RAILROAD SQ
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-6139
Mailing Address - Country:US
Mailing Address - Phone:207-873-1181
Mailing Address - Fax:207-873-1186
Practice Address - Street 1:13 RAILROAD SQ
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-6139
Practice Address - Country:US
Practice Address - Phone:207-873-1181
Practice Address - Fax:207-873-1186
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME015836207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME000206031Medicaid
ME000206031Medicaid
MEPHMM9484Medicare ID - Type Unspecified