Provider Demographics
NPI:1679873350
Name:HAVILAND, JULIE PARKER (PA-C)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:PARKER
Last Name:HAVILAND
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 POND PARK RD.
Mailing Address - Street 2:STE. 102
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-4309
Mailing Address - Country:US
Mailing Address - Phone:781-337-5555
Mailing Address - Fax:781-331-0300
Practice Address - Street 1:2 POND PARK RD.
Practice Address - Street 2:STE. 102
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-4309
Practice Address - Country:US
Practice Address - Phone:781-337-5555
Practice Address - Fax:781-331-0300
Is Sole Proprietor?:No
Enumeration Date:2010-10-27
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA 4079363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical