Provider Demographics
NPI:1699390237
Name:GAN, EMILY (PA)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:GAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:5 CABOT RD UNIT 335
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-5287
Mailing Address - Country:US
Mailing Address - Phone:860-593-2273
Mailing Address - Fax:
Practice Address - Street 1:1305 POST RD STE 310
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-6016
Practice Address - Country:US
Practice Address - Phone:203-259-7709
Practice Address - Fax:203-259-7709
Is Sole Proprietor?:No
Enumeration Date:2020-06-09
Last Update Date:2024-07-17
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant