Provider Demographics
NPI:1346250784
Name:FIESCHKO, JULIE THERESE (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:THERESE
Last Name:FIESCHKO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:JULIE
Other - Middle Name:FIESCHKO
Other - Last Name:KELLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1507 MILLER ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-6543
Mailing Address - Country:US
Mailing Address - Phone:717-273-6948
Mailing Address - Fax:717-270-1379
Practice Address - Street 1:1700 S LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-7529
Practice Address - Country:US
Practice Address - Phone:717-272-6621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD024648E2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology