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General NPI Number Information
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NPI Number | 1801126354
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Entity Type | Organization
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Legal Business Name | JULIANNE STOUGHTON, MD
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Dates
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Enumeration Date | 01/06/2010
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Last Update Date | 01/06/2010
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Provider Practice Location Address
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Address Line | 92 MONTVALE AVE STE 3200
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City | STONEHAM
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State | MA
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Zip | 02180-3660
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Country | US
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Telephone | 781-438-8117
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Fax | 781-438-8116
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Provider Business Mailing Address
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Address Line | 92 MONTVALE AVE STE 3200
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City | STONEHAM
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State | MA
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Zip | 02180-3660
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Country | US
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Telephone | 781-438-8117
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Fax | 781-438-8116
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | MS. CYNTHIA M BANDA
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Credential |
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Telephone | 781-438-8117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 79594
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License Number State | MA
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