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General NPI Number Information
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NPI Number | 1871171736
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Entity Type | Individual
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Provider Name | EMILY MARIE MASTERSON
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Gender | Female
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Dates
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Enumeration Date | 03/31/2021
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 77 NEALY AVE
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City | HAMPTON
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State | VA
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Zip | 23665-2040
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Country | US
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Telephone | 757-225-7630
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Fax |
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Provider Business Mailing Address
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Address Line | 4513 NEWPORT AVE
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City | NORFOLK
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State | VA
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Zip | 23508-2744
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Country | US
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Telephone | 603-443-7484
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 0101285029
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License Number State | VA
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