Provider Demographics
NPI:1851347504
Name:ULTMANN, MONICA (MD)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:ULTMANN
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 1:800 WASHINGTON STREET
Mailing Address - Street 2:SUITE #334
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02411
Mailing Address - Country:US
Mailing Address - Phone:617-636-7548
Mailing Address - Fax:
Practice Address - Street 1:800 WASHINGTON STREET
Practice Address - Street 2:SUITE #334
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02411
Practice Address - Country:US
Practice Address - Phone:617-636-7548
Practice Address - Fax:617-636-5621
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6F04208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics