Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | MD049261 | DC |
NPI | 1538666250 |
---|---|
Provider Name | Mickey Emmanuel |
First Address | Washington, DC 20010-3531 |
Second Address | Washington, DC 20010-2916 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2018 |
Last Update Date | 26/04/2021 |