Provider Demographics
NPI:1376599019
Name:DODGE, JULIE STONE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:STONE
Last Name:DODGE
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4321 MEDICAL PARK DR
Mailing Address - Street 2:STE 102
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2199
Mailing Address - Country:US
Mailing Address - Phone:919-220-7546
Mailing Address - Fax:919-220-5805
Practice Address - Street 1:4321 MEDICAL PARK DR
Practice Address - Street 2:STE 102
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2199
Practice Address - Country:US
Practice Address - Phone:919-220-7546
Practice Address - Fax:919-220-5805
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC103908207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2766353Medicare PIN