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General NPI Number Information
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NPI Number | 1932906385
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Entity Type | Organization
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Legal Business Name | EMERALD MEDICAL PRACTICE PA
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Dates
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Enumeration Date | 02/25/2025
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Last Update Date | 03/28/2025
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Provider Practice Location Address
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Address Line | 1743 SIDEWINDER DRIVE
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City | PARK CITY
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State | UT
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Zip | 84060
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Country | US
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Telephone | 307-840-9834
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Fax | 833-450-0933
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Provider Business Mailing Address
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Address Line | 1743 SIDEWINDER DRIVE UNIT 114
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City | PARK CITY
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State | UT
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Zip | 84060
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Country | US
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Telephone | 307-840-9834
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Fax | 833-450-0933
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Authorized Official
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Title or Position | PRESIDENT
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Name | ASHWIN MURALIDHARAN
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Credential |
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Telephone | 307-840-9834
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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