MEDICARE: DR. JUDITH GILMARTIN PACKER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	47735	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0187127	OTHER	MA	MASSHEALTH PROVIDER NUMBE
2	0187127	OTHER	MA	PCC#

General Provider Information

NPI Number	:	1831192566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUDITH GILMARTIN PACKER M.D.

Provider Business Mailing Address
First Line	:	949 CENTRE ST
Second Line	:
City	:	NEWTON
State	:	MA
Zip	:	02459-1235
Country	:	US
Telephone Number	:	617-519-6099
Fax Number	:

Provider Business Practice Location Address
First Line	:	949 CENTRE ST
Second Line	:
City	:	NEWTON
State	:	MA
Zip	:	02459-1235
Country	:	US
Telephone Number	:	617-519-6099
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	03/29/2016

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