Provider Demographics
NPI:1841234416
Name:REDMON, JULIE ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:ANN
Last Name:REDMON
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 1:5219 HICKORY PARK DR.
Mailing Address - Street 2:SUITE C
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059
Mailing Address - Country:US
Mailing Address - Phone:804-228-4480
Mailing Address - Fax:804-228-4484
Practice Address - Street 1:5219 HICKORY PARK DR.
Practice Address - Street 2:SUITE C
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059
Practice Address - Country:US
Practice Address - Phone:804-228-4480
Practice Address - Fax:804-228-4484
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101049959207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010351511Medicaid
VA000X178C01Medicare ID - Type Unspecified
VA010351511Medicaid