Healthcare Provider Details

I. General information

NPI: 1073662037
Provider Name (Legal Business Name): JULIA FOWLER AQUINO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 12/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 2ND ST PH 15
CAMBRIDGE MA
02141-2147
US

IV. Provider business mailing address

110 2ND ST PH 15
CAMBRIDGE MA
02141-2147
US

V. Phone/Fax

Practice location:
  • Phone: 410-908-2491
  • Fax:
Mailing address:
  • Phone: 410-908-2491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberP19972
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberD67179
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: