Basic Information
Provider Information | |||||||||
NPI: | 1992063614 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MACHADO | ||||||||
FirstName: | JULIE | ||||||||
MiddleName: | CHRISTINE | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | KOGUT | ||||||||
OtherFirstName: | JULIE | ||||||||
OtherMiddleName: | CHRISTINE | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MD | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 448 | ||||||||
Address2: |   | ||||||||
City: | EAST PETERSBURG | ||||||||
State: | PA | ||||||||
PostalCode: | 175200448 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7173917092 | ||||||||
FaxNumber: | 7177352069 | ||||||||
Practice Location | |||||||||
Address1: | 1120 COCOA AVE | ||||||||
Address2: |   | ||||||||
City: | HERSHEY | ||||||||
State: | PA | ||||||||
PostalCode: | 17033 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7175310003 | ||||||||
FaxNumber: | 7178774864 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/01/2012 | ||||||||
LastUpdateDate: | 01/03/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | MD455477 | PA | N |   | Allopathic & Osteopathic Physicians | Hospitalist |   | 207R00000X | MD455477 | PA | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 103038971 | 05 | PA |   | MEDICAID |