Healthcare Provider Details

I. General information

NPI: 1679655047
Provider Name (Legal Business Name): JULIA R KOEHLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 01/22/2020
Certification Date: 01/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE
BOSTON MA
02115-5724
US

IV. Provider business mailing address

300 LONGWOOD AVENUE ENDERS 7
JAMAICA PLAIN MA
02130-2732
US

V. Phone/Fax

Practice location:
  • Phone: 617-919-2900
  • Fax: 617-730-0254
Mailing address:
  • Phone: 617-919-2900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number157918
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: