Provider Demographics
NPI:1588265037
Name:PAEZ, JULIE LOUISE
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:LOUISE
Last Name:PAEZ
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 1:113 JASONS RDG
Mailing Address - Street 2:
Mailing Address - City:SMITHSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21783-1564
Mailing Address - Country:US
Mailing Address - Phone:301-471-0436
Mailing Address - Fax:
Practice Address - Street 1:11110 MEDICAL CAMPUS RD STE 249
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-6756
Practice Address - Country:US
Practice Address - Phone:301-714-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-02
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MDR157477176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program