Provider Demographics
NPI:1730114083
Name:D'AMORA, JULIA (DO)
Entity Type:Individual
Prefix:DR
First Name:JULIA
Middle Name:
Last Name:D'AMORA
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:PO BOX 40032
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24022-0032
Mailing Address - Country:US
Mailing Address - Phone:540-224-5175
Mailing Address - Fax:540-985-5329
Practice Address - Street 1:2001 CRYSTAL SPRING AVE SW
Practice Address - Street 2:SUITE 302
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-2462
Practice Address - Country:US
Practice Address - Phone:540-981-7653
Practice Address - Fax:540-981-7469
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002852A207P00000X
VA0102-201235207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN220140NMedicaid
IN02002852AOtherINDIANA LICENSE
VA1730114083Medicaid
IN02002852BOtherCSR
IN02002852BOtherCSR
000895C51Medicare PIN
IN02002852AOtherINDIANA LICENSE
P00008383Medicare PIN
IN02002852BOtherCSR
015708C47Medicare PIN