Provider Demographics
NPI:1801126354
Name:JULIANNE STOUGHTON, MD
Entity type:Organization
Organization Name:JULIANNE STOUGHTON, MD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BANDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-438-8117
Mailing Address - Street 1:92 MONTVALE AVE STE 3200
Mailing Address - Street 2:
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-3660
Mailing Address - Country:US
Mailing Address - Phone:781-438-8117
Mailing Address - Fax:781-438-8116
Practice Address - Street 1:92 MONTVALE AVE STE 3200
Practice Address - Street 2:
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-3660
Practice Address - Country:US
Practice Address - Phone:781-438-8117
Practice Address - Fax:781-438-8116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA79594208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9726772Medicaid
MAM18105OtherBCBS OF MA
MAM21236Medicare PIN