Provider Demographics
NPI:1720253396
Name:CAFFREY, JULIE A (DO)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:CAFFREY
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 1:4940 EASTERN AVENUE
Mailing Address - Street 2:SUITE P3-4-11
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224
Mailing Address - Country:US
Mailing Address - Phone:410-550-0886
Mailing Address - Fax:410-550-8161
Practice Address - Street 1:4940 EASTERN AVENUE
Practice Address - Street 2:BURN CENTER
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224
Practice Address - Country:US
Practice Address - Phone:410-550-0886
Practice Address - Fax:410-550-8161
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH77803208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD089829500Medicaid
MD089829500Medicaid