Provider Demographics
NPI:1487924445
Name:MCGONDEL, JULIE MARIE (NP)
Entity type:Individual
Prefix:MS
First Name:JULIE
Middle Name:MARIE
Last Name:MCGONDEL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:JAMGOCHIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6 GREENWOOD AVENUE
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801
Mailing Address - Country:US
Mailing Address - Phone:857-327-5347
Mailing Address - Fax:508-230-9772
Practice Address - Street 1:45 DAN ROAD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021
Practice Address - Country:US
Practice Address - Phone:781-867-2050
Practice Address - Fax:978-794-2007
Is Sole Proprietor?:No
Enumeration Date:2012-01-09
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2259262363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS400124164Medicare PIN