Provider Demographics
NPI:1194783563
Name:REIMANN, JULIE D (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:D
Last Name:REIMANN
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 WELLS AVE
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-3225
Mailing Address - Country:US
Mailing Address - Phone:855-644-3376
Mailing Address - Fax:617-658-9399
Practice Address - Street 1:2 WELLS AVE
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459-3225
Practice Address - Country:US
Practice Address - Phone:855-644-3376
Practice Address - Fax:617-658-9399
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA227461207ZP0101X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2012REOtherBLUE SHIELD #
WA8496978Medicaid
WA8496978Medicaid
WA8869411Medicare PIN