Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | P19972 | MD |
N | 2080P0204X | Pediatric Emergency Doctor | D67179 | MD |
NPI | 1073662037 |
---|---|
Provider Name | Dr. Julia Fowler Aquino |
First Address | Cambridge, MA 02141-2147 |
Second Address | Cambridge, MA 02141-2147 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2007 |
Last Update Date | 08/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
018261300 | (05) | MD |