Basic Information
| Provider Information | |||||||||
| NPI: | 1659846269 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PERTA | ||||||||
| FirstName: | JULIE | ||||||||
| MiddleName: | MARTINA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10809 HAMPTON MILL TER APT 100 | ||||||||
| Address2: | |||||||||
| City: | NORTH BETHESDA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208525461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7176451616 | ||||||||
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| Practice Location | |||||||||
| Address1: | 18101 PRINCE PHILIP DR | ||||||||
| Address2: | |||||||||
| City: | OLNEY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208321514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017748882 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2018 | ||||||||
| LastUpdateDate: | 11/27/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 0110006369 | VA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AM0700X | C06967 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.