MEDICARE: EMILY ACKERMAN M.D. LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MD11830	RI

General Provider Information

NPI Number	:	1881925493
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMILY ACKERMAN M.D. LLC

Provider Business Mailing Address
First Line	:	594 GREAT RD
Second Line	:	SUITE 102B
City	:	NORTH SMITHFIELD
State	:	RI
Zip	:	02896-6810
Country	:	US
Telephone Number	:	401-768-3700
Fax Number	:	401-768-3703

Provider Business Practice Location Address
First Line	:	594 GREAT RD
Second Line	:	SUITE 102B
City	:	NORTH SMITHFIELD
State	:	RI
Zip	:	02896-6810
Country	:	US
Telephone Number	:	401-768-3700
Fax Number	:	401-768-3703

Authorized Official
Title or Position	:	OWNER
Name	:	DR. EMILY ACKERMAN
Credential	:	MD
Telephone Number	:	401-768-3700

Provider Enumeration Date	:	01/21/2010
Last Update Date	:	01/21/2010

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