Basic Information
Provider Information
NPI: 1033556808
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TODD
FirstName: JULIA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 10800 KNIGHTS RD
Address2:  
City: PHILADELPHIA
State: PA
PostalCode: 191144200
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 10800 KNIGHTS RD
Address2:  
City: PHILADELPHIA
State: PA
PostalCode: 191144200
CountryCode: US
TelephoneNumber: 2156125161
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/03/2013
LastUpdateDate: 01/02/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XOS017372PAN Allopathic & Osteopathic PhysiciansFamily Medicine 
390200000XOT015197PAY Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


Home