Basic Information
Provider Information
NPI: 1609216191
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FLEMING
FirstName: JULIA
MiddleName: GREEN
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1340 BOYLSTON ST
Address2:  
City: BOSTON
State: MA
PostalCode: 022154302
CountryCode: US
TelephoneNumber: 6172670900
FaxNumber: 6179275495
Practice Location
Address1: 1340 BOYLSTON ST
Address2:  
City: BOSTON
State: MA
PostalCode: 02215
CountryCode: US
TelephoneNumber: 6172670900
FaxNumber: 6179275495
Other Information
ProviderEnumerationDate: 06/27/2013
LastUpdateDate: 10/01/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X280647MAY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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