Basic Information
| Provider Information | |||||||||
| NPI: | 1972958239 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MANCINI | ||||||||
| FirstName: | JULIANA | ||||||||
| MiddleName: | BURSIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 E WELLS ST | ||||||||
| Address2: | APT 472 | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212304844 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4129159048 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2415 MUSGROVE RD STE 105 | ||||||||
| Address2: | |||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209045224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3019890193 | ||||||||
| FaxNumber: | 3018792325 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2016 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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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 | 363AM0700X | C06151 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.