Provider Demographics
NPI:1831192566
Name:PACKER, JUDITH GILMARTIN (MD)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:GILMARTIN
Last Name:PACKER
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 1:949 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-1235
Mailing Address - Country:US
Mailing Address - Phone:617-519-6099
Mailing Address - Fax:
Practice Address - Street 1:949 CENTRE ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459-1235
Practice Address - Country:US
Practice Address - Phone:617-519-6099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA47735207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0187127OtherMASSHEALTH PROVIDER NUMBE
MA0187127OtherPCC#
MA0187127OtherPCC#
C25161Medicare ID - Type Unspecified