Provider Demographics
NPI:1144468737
Name:MCCAMMON, JULIE K (MD)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:K
Last Name:MCCAMMON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:527 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-9007
Mailing Address - Country:US
Mailing Address - Phone:304-933-3868
Mailing Address - Fax:304-933-3870
Practice Address - Street 1:527 MEDICAL PARK DR
Practice Address - Street 2:SUITE 104
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-9007
Practice Address - Country:US
Practice Address - Phone:304-933-3868
Practice Address - Fax:304-933-3870
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-04
Last Update Date:2015-01-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WVWV1559207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0091494000Medicaid
WVWV1559OtherTHE HEALTH PLAN
WV001710806OtherMOUNTAIN STATE BC/BS
WVDO6136OtherRAILROAD MEDICARE
WVDO6136OtherRAILROAD MEDICARE