Healthcare Provider Details

I. General information

NPI: 1336293760
Provider Name (Legal Business Name): JULIE O DENNIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 05/03/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 MALL RD LAHEY CLINIC
BURLINGTON MA
01805-0001
US

IV. Provider business mailing address

41 MALL RD LAHEY CLINIC
BURLINGTON MA
01805-0001
US

V. Phone/Fax

Practice location:
  • Phone: 781-744-8580
  • Fax: 781-744-5253
Mailing address:
  • Phone: 781-744-8580
  • Fax: 781-744-5253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number225335
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number16678
License Number StateNH
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number237770
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: