Provider Demographics
NPI:1427200625
Name:PADIERNOS, EMERSON BAES (MSN, ANP-BC, OCN)
Entity Type:Individual
Prefix:MR
First Name:EMERSON
Middle Name:BAES
Last Name:PADIERNOS
Suffix:
Gender:M
Credentials:MSN, ANP-BC, OCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 418283
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-8283
Mailing Address - Country:US
Mailing Address - Phone:703-558-1544
Mailing Address - Fax:
Practice Address - Street 1:3800 RESERVOIR RD, NW, 2ND FLOOR - PODIUM C
Practice Address - Street 2:GEORGETOWN UNIVERSITY HOSPITAL, LOMBARDI CANCER CENTER
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007
Practice Address - Country:US
Practice Address - Phone:202-444-2553
Practice Address - Fax:202-444-3655
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1015486363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC159991YT2Medicare PIN