Healthcare Provider Details

I. General information

NPI: 1083077366
Provider Name (Legal Business Name): EMILY SLOSBERG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY TWAALFHOVEN MD

II. Dates (important events)

Enumeration Date: 04/03/2016
Last Update Date: 03/25/2022
Certification Date: 03/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

158 PLEASANT STREET
BROCKTON MA
02301
US

IV. Provider business mailing address

158 PLEASANT STREET
BROCKTON MA
02301
US

V. Phone/Fax

Practice location:
  • Phone: 508-894-3363
  • Fax: 508-893-4649
Mailing address:
  • Phone: 508-894-3363
  • Fax: 508-893-4649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1813
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: