Provider Demographics
NPI:1285682856
Name:DEROSA, JULIE K (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:K
Last Name:DEROSA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:640 KOLTER DR
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3570
Mailing Address - Country:US
Mailing Address - Phone:724-357-7196
Mailing Address - Fax:724-357-7279
Practice Address - Street 1:100 NEAL AVE
Practice Address - Street 2:
Practice Address - City:MARION CENTER
Practice Address - State:PA
Practice Address - Zip Code:15759-0267
Practice Address - Country:US
Practice Address - Phone:724-397-5571
Practice Address - Fax:724-397-2800
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD051117L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015888700004Medicaid
PA0000877811Medicare UPIN
PA0015888700004Medicaid