Provider Demographics
NPI:1053841171
Name:KELLOGG, EMILY LAUREN (MD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:LAUREN
Last Name:KELLOGG
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:290 COMMONWEALTH AVE APT B
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-2403
Mailing Address - Country:US
Mailing Address - Phone:315-767-2322
Mailing Address - Fax:
Practice Address - Street 1:45 DIMOCK ST
Practice Address - Street 2:
Practice Address - City:ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02119-1208
Practice Address - Country:US
Practice Address - Phone:617-442-8800
Practice Address - Fax:617-541-8334
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA286729207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology