Provider Demographics
NPI:1255315958
Name:HAJDENBERG, JULIO JOSE (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIO
Middle Name:JOSE
Last Name:HAJDENBERG
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:JAMAICA PLAIN VA MEDICAL CENTER
Mailing Address - Street 2:130 S. HUNTINGTON AVE.
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130
Mailing Address - Country:US
Mailing Address - Phone:617-232-9500
Mailing Address - Fax:407-425-5203
Practice Address - Street 1:JAMAICA PLAIN VA MEDICAL CENTER/HEMATOLOGY-ONCOLOGY
Practice Address - Street 2:130 S. HUNTINGTON AVE.
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130
Practice Address - Country:US
Practice Address - Phone:617-232-9500
Practice Address - Fax:407-425-5203
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME73222207RH0003X
MA79524207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254236600Medicaid
FLG50745Medicare UPIN
FL41389XMedicare PIN
FL254236600Medicaid