Healthcare Provider Details

I. General information

NPI: 1588082200
Provider Name (Legal Business Name): JULIA O. BALTZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2014
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1672 S COUNTY TRL STE 101
EAST GREENWICH RI
02818-5099
US

IV. Provider business mailing address

526 MAIN ST STE 302
ACTON MA
01720-3310
US

V. Phone/Fax

Practice location:
  • Phone: 401-885-7546
  • Fax: 401-885-6640
Mailing address:
  • Phone: 978-371-7010
  • Fax: 978-371-0522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number275273
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number042-0017856
License Number StateVT
# 3
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD16273
License Number StateRI
# 4
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number042-0017856
License Number StateVT
# 5
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberMD16273
License Number StateRI
# 6
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number275273
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: