Provider Demographics
NPI:1629056700
Name:JULIAN, WILLIAM A (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:A
Last Name:JULIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3105 WESTERN BRANCH BLVD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5543
Mailing Address - Country:US
Mailing Address - Phone:757-452-3400
Mailing Address - Fax:757-452-3404
Practice Address - Street 1:3105 WESTERN BRANCH BLVD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5540
Practice Address - Country:US
Practice Address - Phone:757-452-3400
Practice Address - Fax:757-452-3404
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101046543208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007502028Medicaid
VA25006OtherSENTARA HEALTHCARE
VA332754OtherANTHEM BC BS
VA007502028Medicaid
VA25006OtherSENTARA HEALTHCARE
VA340000584Medicare ID - Type Unspecified