Healthcare Provider Details

I. General information

NPI: 1508020199
Provider Name (Legal Business Name): EMERSON PRACTICE ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2008
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 OLD ROAD TO NINE ACRE CORNER
CONCORD MA
01742-4159
US

IV. Provider business mailing address

PO BOX 411581
BOSTON MA
02241-2503
US

V. Phone/Fax

Practice location:
  • Phone: 978-287-3022
  • Fax:
Mailing address:
  • Phone: 978-287-3000
  • Fax: 978-287-3022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number StateMA
# 5
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateMA
# 6
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateMA

VIII. Authorized Official

Name: SCOTT T KOSOWICZ
Title or Position: SR. DIRECTOR FINANCE
Credential:
Phone: 978-287-7496