Healthcare Provider Details

I. General information

NPI: 1700867462
Provider Name (Legal Business Name): EMINE NALAN WARD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 12/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 OCEAN AVE REVERE HEALTH CARE CENTER
REVERE MA
02151-3675
US

IV. Provider business mailing address

PO BOX 9142 MASS GENERAL PHYSICIAN ORGANIZATION
CHARLESTOWN MA
02129-9142
US

V. Phone/Fax

Practice location:
  • Phone: 781-485-6118
  • Fax: 781-485-6119
Mailing address:
  • Phone: 617-643-2768
  • Fax: 617-248-0070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number202793
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number202793
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: