Provider Demographics
NPI:1659766483
Name:MACNEIL, JULIE (MD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:MACNEIL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:MACNEIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:360 STATE ST APT 2021
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3619
Mailing Address - Country:US
Mailing Address - Phone:501-231-7169
Mailing Address - Fax:
Practice Address - Street 1:290 WESTERN BLVD
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-1236
Practice Address - Country:US
Practice Address - Phone:888-344-0007
Practice Address - Fax:860-652-9277
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-30
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-11029208000000X
CT62394208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR228937001Medicaid