Provider Demographics
NPI:1295855658
Name:JULIANNE STOUGHTON MD PC
Entity Type:Organization
Organization Name:JULIANNE STOUGHTON MD PC
Other - Org Name:VEIN SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JULIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:STOUGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-438-8117
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:02180-3647
Mailing Address - Country:US
Mailing Address - Phone:781-438-8117
Mailing Address - Fax:
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:02180-3647
Practice Address - Country:US
Practice Address - Phone:781-438-8117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9726772Medicaid
MA9726772Medicaid
MAF84163Medicare UPIN