Provider Demographics
NPI:1962058370
Name:WEBER, EMMA KENNEDY (PA)
Entity type:Individual
Prefix:MRS
First Name:EMMA
Middle Name:KENNEDY
Last Name:WEBER
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:9410 LOCUST HILL RD
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-3961
Mailing Address - Country:US
Mailing Address - Phone:301-767-7851
Mailing Address - Fax:
Practice Address - Street 1:6790 WOOD RIDGE DR
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:VA
Practice Address - Zip Code:23061-4377
Practice Address - Country:US
Practice Address - Phone:804-693-6527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant