Individual
JULIE MACNEIL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
290 WESTERN BLVD, GLASTONBURY, CT 06033-1236
(888) 344-0007
(860) 652-9277
Mailing address
360 STATE ST APT 2021, NEW HAVEN, CT 06510-3619
(501) 231-7169
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
62394
CT
208000000X
Pediatrics Physician
E-11029
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
228937001
—
AR
Enumeration date
03/30/2015
Last updated
07/10/2019
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