Healthcare Provider Details

I. General information

NPI: 1689240129
Provider Name (Legal Business Name): JULIA BUTLER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2021
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 PARK ST APT 2
WAKEFIELD MA
01880-5041
US

IV. Provider business mailing address

725 ALBANY ST STE 3B
BOSTON MA
02118-3549
US

V. Phone/Fax

Practice location:
  • Phone: 978-476-1618
  • Fax:
Mailing address:
  • Phone: 978-476-1618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberPA8116
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: