Healthcare Provider Details

I. General information

NPI: 1962058370
Provider Name (Legal Business Name): EMMA KENNEDY WEBER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2019
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 GLENEAGLES CT STE 204
TOWSON MD
21286-2236
US

IV. Provider business mailing address

PO BOX 23329
NEW YORK NY
10087-3329
US

V. Phone/Fax

Practice location:
  • Phone: 443-351-3376
  • Fax: 410-296-5463
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0009433
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: