Provider Demographics
NPI:1467417626
Name:THIBERT, JULIE S (DO)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:S
Last Name:THIBERT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:MA
Mailing Address - Zip Code:02766-1243
Mailing Address - Country:US
Mailing Address - Phone:508-824-0243
Mailing Address - Fax:508-880-1906
Practice Address - Street 1:184 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:MA
Practice Address - Zip Code:02766-1243
Practice Address - Country:US
Practice Address - Phone:508-824-0243
Practice Address - Fax:508-880-1906
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA218586207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2013720Medicaid
MAA35686Medicare ID - Type Unspecified
MA2013720Medicaid