Healthcare Provider Details

I. General information

NPI: 1467125401
Provider Name (Legal Business Name): EMERSON HURAJT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2021
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5058 LERCH DR
SHADY SIDE MD
20764-9652
US

IV. Provider business mailing address

5058 LERCH DR
SHADY SIDE MD
20764-9652
US

V. Phone/Fax

Practice location:
  • Phone: 443-975-3414
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: