Provider Demographics
NPI:1992063614
Name:MACHADO, JULIE CHRISTINE (MD)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:CHRISTINE
Last Name:MACHADO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JULIE
Other - Middle Name:CHRISTINE
Other - Last Name:KOGUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 448
Mailing Address - Street 2:
Mailing Address - City:EAST PETERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17520-0448
Mailing Address - Country:US
Mailing Address - Phone:717-391-7092
Mailing Address - Fax:717-735-2069
Practice Address - Street 1:1120 COCOA AVE
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033
Practice Address - Country:US
Practice Address - Phone:717-531-0003
Practice Address - Fax:717-877-4864
Is Sole Proprietor?:No
Enumeration Date:2012-05-01
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD455477208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103038971Medicaid
PA103038971Medicaid