Basic Information
Provider Information | |||||||||
NPI: | 1770662462 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | JULIEN | ||||||||
FirstName: | PAUL | ||||||||
MiddleName: | M | ||||||||
NamePrefix: | MR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 808 | ||||||||
Address2: |   | ||||||||
City: | NEWPORT | ||||||||
State: | VT | ||||||||
PostalCode: | 05855 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8023349009 | ||||||||
FaxNumber: | 8023349022 | ||||||||
Practice Location | |||||||||
Address1: | 189 PROUTY DR | ||||||||
Address2: |   | ||||||||
City: | NEWPORT | ||||||||
State: | VT | ||||||||
PostalCode: | 058559326 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8023343262 | ||||||||
FaxNumber: | 8023349022 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/03/2006 | ||||||||
LastUpdateDate: | 06/29/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 06/29/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 0420010859 | VT | Y |   | Allopathic & Osteopathic Physicians | Otolaryngology |   |
ID Information
ID | Type | State | Issuer | Description | 68401 | 01 | VT | BCBS VT | OTHER | 30205421 | 01 | NH | MEAID NH | OTHER | 1011153 | 05 | VT |   | MEDICAID |