Healthcare Provider Details

I. General information

NPI: 1528118023
Provider Name (Legal Business Name): JULIANNE S FOSTER P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 COMMONWEALTH AVE
BOSTON MA
02215-1001
US

IV. Provider business mailing address

46 MILL ST
NEWTON MA
02459-1125
US

V. Phone/Fax

Practice location:
  • Phone: 617-616-1600
  • Fax:
Mailing address:
  • Phone: 617-965-2406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number416
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: