Healthcare Provider Details

I. General information

NPI: 1831192566
Provider Name (Legal Business Name): JUDITH GILMARTIN PACKER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 03/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

949 CENTRE ST
NEWTON MA
02459-1235
US

IV. Provider business mailing address

949 CENTRE ST
NEWTON MA
02459-1235
US

V. Phone/Fax

Practice location:
  • Phone: 617-519-6099
  • Fax:
Mailing address:
  • Phone: 617-519-6099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number47735
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: