Healthcare Provider Details

I. General information

NPI: 1851347504
Provider Name (Legal Business Name): MONICA ULTMANN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 04/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WASHINGTON STREET SUITE #334
BOSTON MA
02411
US

IV. Provider business mailing address

800 WASHINGTON STREET SUITE #334
BOSTON MA
02411
US

V. Phone/Fax

Practice location:
  • Phone: 617-636-7548
  • Fax: 617-636-5621
Mailing address:
  • Phone: 617-636-7548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR6F04
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: