Provider Demographics
NPI:1205095593
Name:WISNIEWSKI, JULIA A (MD)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:A
Last Name:WISNIEWSKI
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 1:5430 CAMPBELL BLVD SUITE 103
Mailing Address - Street 2:
Mailing Address - City:WHITE MARSH
Mailing Address - State:MD
Mailing Address - Zip Code:21162
Mailing Address - Country:US
Mailing Address - Phone:410-933-9404
Mailing Address - Fax:443-868-7406
Practice Address - Street 1:5430 CAMPBELL BLVD SUITE 103
Practice Address - Street 2:
Practice Address - City:WHITE MARSH
Practice Address - State:MD
Practice Address - Zip Code:21162
Practice Address - Country:US
Practice Address - Phone:410-933-9404
Practice Address - Fax:443-868-7406
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2022-05-18
Deactivation Date:2022-04-08
Deactivation Code:
Reactivation Date:2022-05-17
Provider Licenses
StateLicense IDTaxonomies
NY245804207R00000X
VA01012479022080P0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine