Provider Demographics
NPI:1619541810
Name:BLASSEL, EMMA (MD)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:BLASSEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BASSIMA
Other - Middle Name:
Other - Last Name:AL MAHMOUD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:M
Mailing Address - Street 1:75 FRANCIS ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6106
Mailing Address - Country:US
Mailing Address - Phone:617-935-5797
Mailing Address - Fax:
Practice Address - Street 1:75 FRANCIS ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6106
Practice Address - Country:US
Practice Address - Phone:617-935-5797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-13
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2858942085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging