Juliana H. J. Mortenson, M.D.

Key facts

NPI

1972923985

Entity type

Individual (NPI type 1)

Primary specialty

General Practice Physician 208D00000X

License

D67643 (MD)

Practice address

420 W Craighill Channel Dr
Perryville, MD 21903-2523

Phone

(443) 309-3126

NPI assigned

Apr 17, 2014

Sex

Female

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Credentials

Doctor of Medicine

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 17, 2014.

{
    "created_epoch": "1397692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1397692800000",
    "number": "1972923985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 310",
            "city": "NORTH EAST",
            "state": "MD",
            "postal_code": "219010310",
            "telephone_number": "443-309-3126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 W CRAIGHILL CHANNEL DR",
            "city": "PERRYVILLE",
            "state": "MD",
            "postal_code": "219032523",
            "telephone_number": "443-309-3126"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORTENSON",
        "first_name": "JULIANA",
        "middle_name": "H. J.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-04-17",
        "last_updated": "2014-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "MD",
            "license": "D67643",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Perryville, MD · General Practice Physician in Maryland