Provider Demographics
NPI:1225476948
Name:EMILE, RALPH J (PA)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:J
Last Name:EMILE
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:291 INDEPENDENCE DR
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-3628
Mailing Address - Country:US
Mailing Address - Phone:617-541-6560
Mailing Address - Fax:
Practice Address - Street 1:701 METROPOLITAN AVE # 2
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:MA
Practice Address - Zip Code:02136-3107
Practice Address - Country:US
Practice Address - Phone:617-938-7274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-05
Last Update Date:2019-07-16
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA043397450Medicaid