Provider Demographics
NPI:1427071414
Name:BRODY, JULIA B (MD)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:B
Last Name:BRODY
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 1:1726 S BROAD ST
Mailing Address - Street 2:STE 103
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19145
Mailing Address - Country:US
Mailing Address - Phone:215-463-5008
Mailing Address - Fax:215-463-4223
Practice Address - Street 1:1726 S BROAD ST
Practice Address - Street 2:STE 103
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19145-2300
Practice Address - Country:US
Practice Address - Phone:215-463-5008
Practice Address - Fax:215-463-4223
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMB026675E207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01085582601Medicaid
PA01085582601Medicaid
B96890Medicare UPIN