Healthcare Provider Details

I. General information

NPI: 1306929427
Provider Name (Legal Business Name): NORMAN DAVID EMERSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 02/04/2022
Certification Date: 02/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12719 STOTTLEMYER RD
MYERSVILLE MD
21773-9727
US

IV. Provider business mailing address

12719 STOTTLEMYER RD
MYERSVILLE MD
21773-9727
US

V. Phone/Fax

Practice location:
  • Phone: 580-319-8457
  • Fax: 301-965-8727
Mailing address:
  • Phone: 580-319-8457
  • Fax: 301-965-8727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101261544
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0077952
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: