Healthcare Provider Details

I. General information

NPI: 1447011267
Provider Name (Legal Business Name): EMERALD MEDICAL PRACTICE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2024
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1743 SIDEWINDER DR UNIT 114
PARK CITY UT
84060-7322
US

IV. Provider business mailing address

1441 UTE BLVD STE 370
PARK CITY UT
84098-7630
US

V. Phone/Fax

Practice location:
  • Phone: 307-840-9834
  • Fax: 833-450-0933
Mailing address:
  • Phone: 307-840-9834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: ASHWIN MURALIDHARAN
Title or Position: PRESIDENT
Credential:
Phone: 307-840-9834