Provider Demographics
NPI:1285683441
Name:GUTMARK, JULIE G (MD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:G
Last Name:GUTMARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:8630 FENTON ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3806
Mailing Address - Country:US
Mailing Address - Phone:301-588-1177
Mailing Address - Fax:301-589-5245
Practice Address - Street 1:8630 FENTON ST
Practice Address - Street 2:SUITE 130
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3806
Practice Address - Country:US
Practice Address - Phone:301-588-1177
Practice Address - Fax:301-589-5245
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD63190207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD408017300Medicaid
MD020009H08Medicare PIN
MDI35864Medicare UPIN
MD408017300Medicaid
DC020130W31Medicare PIN