Provider Demographics
NPI:1730289703
Name:HENRY, JULIE PATRICIA (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:PATRICIA
Last Name:HENRY
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 1:9004 FERN PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015
Mailing Address - Country:US
Mailing Address - Phone:703-425-5300
Mailing Address - Fax:
Practice Address - Street 1:9004 FERN PARK DRIVE
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015
Practice Address - Country:US
Practice Address - Phone:703-425-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101044681207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC00140004OtherBCBS
0300067OtherUNITED HEALTHCARE
VA0546555OtherANTHEM
VA5920272Medicaid
E27311Medicare UPIN
0300067OtherUNITED HEALTHCARE