Provider Demographics
NPI:1407802309
Name:FARRELL, JULIE A (MD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:FARRELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 632034
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-2034
Mailing Address - Country:US
Mailing Address - Phone:513-852-2451
Mailing Address - Fax:513-852-2441
Practice Address - Street 1:425 HOME ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:OH
Practice Address - Zip Code:45121-1407
Practice Address - Country:US
Practice Address - Phone:937-378-6121
Practice Address - Fax:937-378-7860
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350487582085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
300076825OtherMEDICARE RAILROAD
KY64317548Medicaid
IN200125500AMedicaid
OH0566927Medicaid
000000015875OtherANTHEM
311336104006OtherMEDICAL MUTUAL
OH0566927Medicaid
A81307Medicare UPIN
FA0552545Medicare ID - Type Unspecified