Provider Demographics
NPI:1235312448
Name:TACK, EMILIE (DO)
Entity Type:Individual
Prefix:DR
First Name:EMILIE
Middle Name:
Last Name:TACK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:EMILIE
Other - Middle Name:
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1177 PROVIDENCE HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062
Mailing Address - Country:US
Mailing Address - Phone:781-278-5575
Mailing Address - Fax:781-255-0774
Practice Address - Street 1:1177 PROVIDENCE HIGHWAY
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062
Practice Address - Country:US
Practice Address - Phone:781-278-5575
Practice Address - Fax:781-255-0774
Is Sole Proprietor?:No
Enumeration Date:2007-12-11
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101017260207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology