Provider Demographics
NPI:1437267283
Name:NIMAKO, JULIET (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIET
Middle Name:
Last Name:NIMAKO
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 1:900 WASHINGTON ST STE C
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-3498
Mailing Address - Country:US
Mailing Address - Phone:781-349-8375
Mailing Address - Fax:781-349-8246
Practice Address - Street 1:850 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-6000
Practice Address - Country:US
Practice Address - Phone:781-375-3805
Practice Address - Fax:781-375-3810
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA253849207Q00000X
GA059837207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA24-2444755Medicaid
GA837241476AMedicaid
MA110095010AOtherMASS HEALTH
GA837241476AMedicaid