Provider Demographics
NPI:1538645452
Name:DAHLGARD, JULIA HANNAH (PA-C)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:HANNAH
Last Name:DAHLGARD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:
Other - Last Name:BEVVINO-BERV
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:233 E ST # 3
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-2875
Mailing Address - Country:US
Mailing Address - Phone:203-605-9120
Mailing Address - Fax:
Practice Address - Street 1:30 FRUIT ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2620
Practice Address - Country:US
Practice Address - Phone:617-726-0923
Practice Address - Fax:617-726-6498
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-13
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA6660363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty