Provider Demographics
NPI:1609087774
Name:TIERNEY, EMILY PATRICIA (MD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:PATRICIA
Last Name:TIERNEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 YARMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-3040
Mailing Address - Country:US
Mailing Address - Phone:508-957-1650
Mailing Address - Fax:508-957-1655
Practice Address - Street 1:120 YARMOUTH RD
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3040
Practice Address - Country:US
Practice Address - Phone:508-957-1650
Practice Address - Fax:508-957-1655
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA238976207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110083260AMedicaid
MA110083260AMedicaid
MA001173001Medicare PIN
MAS400278911Medicare PIN