Provider Demographics
NPI:1528389863
Name:O'CONNOR, JULIE ROMBAUT (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:ROMBAUT
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:ROMBAUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1081 VARNUM AVE
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01854
Mailing Address - Country:US
Mailing Address - Phone:978-427-6810
Mailing Address - Fax:978-427-6887
Practice Address - Street 1:1081 VARNUM AVE
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854
Practice Address - Country:US
Practice Address - Phone:978-427-6810
Practice Address - Fax:978-427-6887
Is Sole Proprietor?:No
Enumeration Date:2010-06-22
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILP01908207Q00000X
MA257149207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIRES-000Medicare UPIN