Healthcare Provider Details

I. General information

NPI: 1679873350
Provider Name (Legal Business Name): JULIE PARKER HAVILAND PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2010
Last Update Date: 10/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 POND PARK RD. STE. 102
HINGHAM MA
02043-4309
US

IV. Provider business mailing address

2 POND PARK RD. STE. 102
HINGHAM MA
02043-4309
US

V. Phone/Fax

Practice location:
  • Phone: 781-337-5555
  • Fax: 781-331-0300
Mailing address:
  • Phone: 781-337-5555
  • Fax: 781-331-0300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA 4079
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: