Provider Demographics
NPI:1609197912
Name:WIGTON, JULIE CARROLL (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:CARROLL
Last Name:WIGTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:CARROLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:10700 MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:OH
Mailing Address - Zip Code:45242-3255
Mailing Address - Country:US
Mailing Address - Phone:513-984-5552
Mailing Address - Fax:513-984-5554
Practice Address - Street 1:10700 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:OH
Practice Address - Zip Code:45242-3255
Practice Address - Country:US
Practice Address - Phone:513-984-5552
Practice Address - Fax:513-984-5554
Is Sole Proprietor?:No
Enumeration Date:2010-06-21
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT 197782208000000X
NC201501182208000000X
OH35.128931208000000X
PAMD448100208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics