Healthcare Provider Details

I. General information

NPI: 1184023814
Provider Name (Legal Business Name): EMILY PAYNE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY MOCCIO

II. Dates (important events)

Enumeration Date: 08/19/2014
Last Update Date: 02/10/2021
Certification Date: 02/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 MAGAZINE ST
SPRINGFIELD MA
01109-4016
US

IV. Provider business mailing address

153 MAGAZINE ST
SPRINGFIELD MA
01109-4016
US

V. Phone/Fax

Practice location:
  • Phone: 844-642-9355
  • Fax:
Mailing address:
  • Phone: 844-642-9355
  • Fax: 413-271-7137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA5062
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: