Provider Demographics
NPI:1114041902
Name:DECROOS, EMILY CHOI (MD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:CHOI
Last Name:DECROOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:CHOI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7477 COMMONS BLVD., APT. 731
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421
Mailing Address - Country:US
Mailing Address - Phone:919-451-5685
Mailing Address - Fax:610-872-4258
Practice Address - Street 1:1 MEDICAL CENTER BLVD
Practice Address - Street 2:ACP # 533
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013-3902
Practice Address - Country:US
Practice Address - Phone:610-874-1184
Practice Address - Fax:610-872-4258
Is Sole Proprietor?:No
Enumeration Date:2007-03-18
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2332432084N0008X
PAMD4424452084N0400X
TN500582084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0008XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeuromuscular Medicine