Provider Demographics
NPI:1063469435
Name:VIERA, JULIE A (PAC)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:A
Last Name:VIERA
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:MS
Other - First Name:JULIE
Other - Middle Name:A
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:PO BOX 12622
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4017
Mailing Address - Country:US
Mailing Address - Phone:410-573-9530
Mailing Address - Fax:410-573-9568
Practice Address - Street 1:2000 MEDICAL PKWY
Practice Address - Street 2:SUITE 304
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3742
Practice Address - Country:US
Practice Address - Phone:410-573-9530
Practice Address - Fax:410-573-9569
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0003175363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD601563Y5ZOtherMEDICARE
MD601563Y5ZOtherMEDICARE