Healthcare Provider Details

I. General information

NPI: 1427383645
Provider Name (Legal Business Name): EMERSON PRACTICE ASSOCIATES II, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2009
Last Update Date: 10/28/2021
Certification Date: 10/27/2021
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

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

V. Phone/Fax

Practice location:
  • Phone: 978-287-3234
  • Fax: 978-287-3102
Mailing address:
  • Phone: 978-287-3321
  • Fax: 978-287-3102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number StateMA

VIII. Authorized Official

Name: SCOTT T KOSOWICZ
Title or Position: SR. DIRECTOR FINANCE
Credential:
Phone: 603-393-8256