Provider Demographics
NPI:1548279953
Name:CARSON, JULIA MOORE (DO)
Entity type:Individual
Prefix:DR
First Name:JULIA
Middle Name:MOORE
Last Name:CARSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH YARMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02664-3117
Mailing Address - Country:US
Mailing Address - Phone:720-201-0708
Mailing Address - Fax:888-862-4414
Practice Address - Street 1:93 N MAIN ST
Practice Address - Street 2:
Practice Address - City:S YARMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02664-3117
Practice Address - Country:US
Practice Address - Phone:720-201-0708
Practice Address - Fax:888-862-4414
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2021-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA229943207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine