Provider Demographics
NPI:1619937679
Name:THOMAS, JULIANNE (DO)
Entity Type:Individual
Prefix:DR
First Name:JULIANNE
Middle Name:
Last Name:THOMAS
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 1:2159 WHITE ST
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17404-4943
Mailing Address - Country:US
Mailing Address - Phone:717-846-8791
Mailing Address - Fax:717-846-8410
Practice Address - Street 1:2159 WHITE ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17404-4943
Practice Address - Country:US
Practice Address - Phone:717-846-8791
Practice Address - Fax:717-846-8410
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS012712207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1014613190001Medicaid
PA09568HOZMedicare ID - Type Unspecified
PA1014613190001Medicaid