Healthcare Provider Details

I. General information

NPI: 1801110614
Provider Name (Legal Business Name): KEVIN EMAH MT(ASCP)
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2010
Last Update Date: 03/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 YOUNG ST
GRAND COULEE WA
99133-9703
US

IV. Provider business mailing address

107 YOUNG ST
GRAND COULEE WA
99133-9703
US

V. Phone/Fax

Practice location:
  • Phone: 301-256-4169
  • Fax:
Mailing address:
  • Phone: 301-256-4169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZG1000X
TaxonomyMedical Geneticist (PhD) Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: