Healthcare Provider Details

I. General information

NPI: 1740256395
Provider Name (Legal Business Name): EMILY JANE ACKERMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EMILY J HILE

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 03/29/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

261 MAIN ST STE 102
SLATERSVILLE RI
02876-1015
US

IV. Provider business mailing address

PO BOX 927
SLATERSVILLE RI
02876
US

V. Phone/Fax

Practice location:
  • Phone: 401-597-5656
  • Fax: 401-597-5671
Mailing address:
  • Phone: 401-597-5656
  • Fax: 401-597-5671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number07Q00000X
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD11830
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: