Provider Demographics
NPI:1851338990
Name:JULIE K MCCAMMON MD INC
Entity Type:Organization
Organization Name:JULIE K MCCAMMON MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:KATHRYN
Authorized Official - Last Name:MCCAMMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-933-3868
Mailing Address - Street 1:527 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-9007
Mailing Address - Country:US
Mailing Address - Phone:304-933-3868
Mailing Address - Fax:304-933-3870
Practice Address - Street 1:527 MEDICAL PARK DR
Practice Address - Street 2:SUITE 104
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-9007
Practice Address - Country:US
Practice Address - Phone:304-933-3868
Practice Address - Fax:304-933-3870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVWV15559OtherSTATE LICENSE
WV0091494000Medicaid
C35223Medicare UPIN
WV0091494000Medicaid