Provider Demographics
NPI:1720157357
Name:PADGETT, JULIA K
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:K
Last Name:PADGETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 CONCOURSE BLVD
Mailing Address - Street 2:STE 190
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-5759
Mailing Address - Country:US
Mailing Address - Phone:804-549-4030
Mailing Address - Fax:804-549-4032
Practice Address - Street 1:5207 HICKORY PARK DR
Practice Address - Street 2:SUITE A
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-2624
Practice Address - Country:US
Practice Address - Phone:804-977-8938
Practice Address - Fax:804-762-7102
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101223416207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06778OtherGROUP PTAN