Provider Demographics
NPI:1922174333
Name:MEDOFF, JULIET CLAIRE (RN)
Entity Type:Individual
Prefix:
First Name:JULIET
Middle Name:CLAIRE
Last Name:MEDOFF
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 RITCHIE HWY STE 207
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-3935
Mailing Address - Country:US
Mailing Address - Phone:410-315-9350
Mailing Address - Fax:
Practice Address - Street 1:650 RITCHIE HWY STE 207
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-3935
Practice Address - Country:US
Practice Address - Phone:410-315-9350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR128489163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health