Provider Demographics
NPI:1619078821
Name:HAUER, JULIE M (MD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:M
Last Name:HAUER
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 1:44 BINNEY ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6013
Mailing Address - Country:US
Mailing Address - Phone:617-632-5042
Mailing Address - Fax:
Practice Address - Street 1:44 BINNEY STREET
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-632-5042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN35682208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN92541UNOtherBLUE CROSS BLUE SHIELD
MNHP13484OtherHEALTH PARTNERS
MN1200560OtherMEDICA-CHOICE
MN1000156OtherPREFERRED ONE
MN958707100Medicaid
IA0946921Medicaid
MN1200560OtherMEDICA-PRIMARY
768150OtherARAZ
MT0052312Medicaid
MN100962OtherU CARE
MNF26742Medicare UPIN
MT0052312Medicaid