Provider Demographics
NPI:1033191671
Name:STOUGHTON, JULIANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIANNE
Middle Name:
Last Name:STOUGHTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 MONTVALE AVE
Mailing Address - Street 2:SUITE 3200
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-3660
Mailing Address - Country:US
Mailing Address - Phone:781-438-8117
Mailing Address - Fax:781-438-8116
Practice Address - Street 1:92 MONTVALE AVE
Practice Address - Street 2:SUITE 3200
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-3660
Practice Address - Country:US
Practice Address - Phone:781-438-8117
Practice Address - Fax:781-438-8116
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA79594208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA079594OtherTUFTS HEALTH PLAN
MAJ30769OtherBCBS OF MA
MA3127745Medicaid
MAJ30769OtherBCBS OF MA
F84163Medicare UPIN
MAJ30769Medicare PIN