Provider Demographics
NPI:1972923985
Name:MORTENSON, JULIANA H J (MD)
Entity type:Individual
Prefix:
First Name:JULIANA
Middle Name:H J
Last Name:MORTENSON
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:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:NORTH EAST
Mailing Address - State:MD
Mailing Address - Zip Code:21901-0310
Mailing Address - Country:US
Mailing Address - Phone:443-309-3126
Mailing Address - Fax:
Practice Address - Street 1:420 W CRAIGHILL CHANNEL DR
Practice Address - Street 2:
Practice Address - City:PERRYVILLE
Practice Address - State:MD
Practice Address - Zip Code:21903-2523
Practice Address - Country:US
Practice Address - Phone:443-309-3126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-17
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD67643208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice