Provider Demographics
NPI:1366410789
Name:EBY, EMMET J (MD)
Entity type:Individual
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First Name:EMMET
Middle Name:J
Last Name:EBY
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Gender:M
Credentials:MD
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Mailing Address - Street 1:200 MILL RD
Mailing Address - Street 2:STE 180
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-5252
Mailing Address - Country:US
Mailing Address - Phone:508-973-2000
Mailing Address - Fax:508-973-2000
Practice Address - Street 1:100 ROSEBROOK WAY
Practice Address - Street 2:2ND FLOOR
Practice Address - City:WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02571-1406
Practice Address - Country:US
Practice Address - Phone:508-273-4974
Practice Address - Fax:508-273-4955
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2020-04-21
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Provider Licenses
StateLicense IDTaxonomies
MA59946207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110046019AMedicaid
MAJ0758602Medicare PIN