Provider Demographics
NPI:1487722278
Name:EMERSON, FRED E (MD)
Entity type:Individual
Prefix:DR
First Name:FRED
Middle Name:E
Last Name:EMERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:301C US ROUTE 1
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9701
Mailing Address - Country:US
Mailing Address - Phone:207-396-8600
Mailing Address - Fax:207-396-8632
Practice Address - Street 1:584 ROOSEVELT TRAIL
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062-4904
Practice Address - Country:US
Practice Address - Phone:207-892-3233
Practice Address - Fax:207-893-0752
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD18052207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30208517Medicaid
MA433831099Medicaid
ME001142303Medicare PIN
ME001142302Medicare PIN
MA433831099Medicaid
ME001142301Medicare PIN
ME001142304Medicare PIN
ME001142305Medicare PIN