Provider Demographics
NPI:1184859571
Name:VERNON, JULIE ANN (MD)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:ANN
Last Name:VERNON
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 1:62 NORTHGATE
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-4076
Mailing Address - Country:US
Mailing Address - Phone:860-675-0542
Mailing Address - Fax:
Practice Address - Street 1:62 NORTHGATE
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-4076
Practice Address - Country:US
Practice Address - Phone:860-675-0542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT033571207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTE76453Medicare UPIN