Healthcare Provider Details

I. General information

NPI: 1972820397
Provider Name (Legal Business Name): EMILY DIANE WHITESEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2010
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BROOKLINE AVE # ROSE3
BOSTON MA
02215-5400
US

IV. Provider business mailing address

330 BROOKLINE AVE # ROSE3
BOSTON MA
02215-5400
US

V. Phone/Fax

Practice location:
  • Phone: 617-667-3276
  • Fax:
Mailing address:
  • Phone: 608-695-7749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number258451
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: