Provider Demographics
NPI:1871639286
Name:HARRE, JULIA A (MD)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:A
Last Name:HARRE
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 1:222 AUBURN ST SUITE 205
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103
Mailing Address - Country:US
Mailing Address - Phone:207-797-4024
Mailing Address - Fax:207-797-9793
Practice Address - Street 1:222 AUBURN ST STE 205
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-6004
Practice Address - Country:US
Practice Address - Phone:207-797-4024
Practice Address - Fax:207-797-9793
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME013X30207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME127400000Medicaid
F05767Medicare UPIN
MEMM5473Medicare ID - Type Unspecified