Provider Demographics
NPI:1942783733
Name:GOTTHARDT, JULIA C (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:C
Last Name:GOTTHARDT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:231 ROCKY MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-2727
Mailing Address - Country:US
Mailing Address - Phone:203-313-7406
Mailing Address - Fax:
Practice Address - Street 1:20 YORK ST, CB-2041
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3220
Practice Address - Country:US
Practice Address - Phone:203-688-1734
Practice Address - Fax:203-688-4740
Is Sole Proprietor?:No
Enumeration Date:2018-09-08
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4205207RC0000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease