Provider Demographics
NPI:1639168818
Name:VANEGMOND, JULIET E (MD)
Entity Type:Individual
Prefix:
First Name:JULIET
Middle Name:E
Last Name:VANEGMOND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10026 OLD OCEAN CITY BLVD
Mailing Address - Street 2:BUILDING ONE
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811
Mailing Address - Country:US
Mailing Address - Phone:410-641-9109
Mailing Address - Fax:
Practice Address - Street 1:9733 HEALTHWAY DRIVE
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811
Practice Address - Country:US
Practice Address - Phone:410-641-9109
Practice Address - Fax:410-629-1203
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0056307208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00215721OtherRAILROAD MEDICARE
MD406687100Medicaid
P00215721OtherRAILROAD MEDICARE
MD406687100Medicaid