Provider Demographics
NPI:1245258516
Name:POLUDNIAK, JULIE T (MD)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:T
Last Name:POLUDNIAK
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 1:2600 GLASGOW AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-5703
Mailing Address - Country:US
Mailing Address - Phone:302-273-1317
Mailing Address - Fax:302-273-1581
Practice Address - Street 1:2600 GLASGOW AVE STE 100
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-5703
Practice Address - Country:US
Practice Address - Phone:302-273-1317
Practice Address - Fax:302-273-1581
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0005439207Q00000X
MDD55315207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKP83467ZMedicare ID - Type Unspecified
MDH04875Medicare UPIN