Provider Demographics
NPI:1649630302
Name:SOTHERLAND, JULIANA THEREZINHA FAJOSES (MD)
Entity type:Individual
Prefix:
First Name:JULIANA
Middle Name:THEREZINHA FAJOSES
Last Name:SOTHERLAND
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 1:400 S GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-3776
Mailing Address - Country:US
Mailing Address - Phone:484-822-5205
Mailing Address - Fax:
Practice Address - Street 1:400 S GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-3776
Practice Address - Country:US
Practice Address - Phone:484-822-5205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-24
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD468840207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine