Healthcare Provider Details

I. General information

NPI: 1306945027
Provider Name (Legal Business Name): EMERSON ANESTHESIA ASSOCIATES P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 11/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 OLD ROAD TO 9 ACRE COR
CONCORD MA
01742-4159
US

IV. Provider business mailing address

1342 BELMONT ST SUITE 205
BROCKTON MA
02301-4436
US

V. Phone/Fax

Practice location:
  • Phone: 978-287-3162
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SANJIV KUMAR
Title or Position: TREASURER
Credential: MD
Phone: 978-287-3162