Provider Demographics
NPI:1386750222
Name:THATTASSERY, EMIL G (MD)
Entity type:Individual
Prefix:MR
First Name:EMIL
Middle Name:G
Last Name:THATTASSERY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 TWIN SPRINGS ROAD, CARDIOLOGY DEPT 4TH FLOOR
Mailing Address - Street 2:
Mailing Address - City:HALETHORPE
Mailing Address - State:MD
Mailing Address - Zip Code:21227
Mailing Address - Country:US
Mailing Address - Phone:410-737-5260
Mailing Address - Fax:410-737-5265
Practice Address - Street 1:1701 TWIN SPRINGS ROAD
Practice Address - Street 2:
Practice Address - City:HALETHORPE
Practice Address - State:MD
Practice Address - Zip Code:21227
Practice Address - Country:US
Practice Address - Phone:410-737-5260
Practice Address - Fax:410-737-5265
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2021-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY239469207R00000X
MDD69842207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine