Provider Demographics
NPI:1447612288
Name:CROSS, EMILY R (MD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:R
Last Name:CROSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 MASSACHUSETTS AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2690
Mailing Address - Country:US
Mailing Address - Phone:617-414-5405
Mailing Address - Fax:
Practice Address - Street 1:801 MASSACHUSETTS AVE.
Practice Address - Street 2:CROSSTOWN BLDG FL 7
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-5724
Practice Address - Country:US
Practice Address - Phone:617-414-5946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2782212080S0010X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080S0010XAllopathic & Osteopathic PhysiciansPediatricsSports Medicine