Provider Demographics
NPI:1962443986
Name:BLEYENBERG, JULIE A (DO)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:BLEYENBERG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 CENTRAL AVE.
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-3408
Mailing Address - Country:US
Mailing Address - Phone:603-742-2424
Mailing Address - Fax:603-742-1763
Practice Address - Street 1:700 CENTRAL AVE
Practice Address - Street 2:CENTRAL COMMONS
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-3408
Practice Address - Country:US
Practice Address - Phone:603-742-2424
Practice Address - Fax:603-742-1763
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPENDING207V00000X, 207VC0200X, 207VG0400X
NH13421207VC0200X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VC0200XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyCritical Care Medicine
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2669901Medicaid
OH34-008813OtherLICENSE 7-31-09 EXP
NH3071612Medicaid
OH2669901Medicaid