Provider Demographics
NPI:1023374360
Name:SANVILLE, JULIE LUCY (DO)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:LUCY
Last Name:SANVILLE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:LUCY
Other - Last Name:GRYGUC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:ONE MEDICAL CENTER DRIVE
Mailing Address - Street 2:GASTROENTEROLOGY
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03756-0001
Mailing Address - Country:US
Mailing Address - Phone:603-653-9666
Mailing Address - Fax:603-653-9166
Practice Address - Street 1:ONE MEDICAL CENTER DRIVE
Practice Address - Street 2:GASTROENTEROLOGY
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03756
Practice Address - Country:US
Practice Address - Phone:603-653-9666
Practice Address - Fax:603-653-9166
Is Sole Proprietor?:No
Enumeration Date:2012-04-10
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH19667208000000X, 2080P0206X
RIDO008352080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT6700979Medicaid
NH3101236Medicaid