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: 11/16/2020
Certification Date: 11/16/2020
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

PO BOX 415348
BOSTON MA
02241-5348
US

V. Phone/Fax

Practice location:
  • Phone: 401-885-7546
  • Fax: 401-885-6640
Mailing address:
  • Phone: 800-225-8885
  • Fax: 508-334-8105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number16273
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number275273
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: