Provider Demographics
NPI:1902801541
Name:TINNEY, JULIE (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:
Last Name:TINNEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:754 N HICKORY AVE
Mailing Address - Street 2:STE C
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-3042
Mailing Address - Country:US
Mailing Address - Phone:410-638-8991
Mailing Address - Fax:443-356-4216
Practice Address - Street 1:754 N HICKORY AVE
Practice Address - Street 2:STE C
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-3042
Practice Address - Country:US
Practice Address - Phone:410-803-0578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2017-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD53186207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD404802400Medicaid
MDG94380Medicare UPIN
MD404802400Medicaid