Provider Demographics
NPI:1679950125
Name:BRETON, EMILY (PAC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:BRETON
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 EDGERTON DR STE 1
Mailing Address - Street 2:
Mailing Address - City:NORTH FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02556-2841
Mailing Address - Country:US
Mailing Address - Phone:508-560-2550
Mailing Address - Fax:
Practice Address - Street 1:37 EDGERTON DR STE 1
Practice Address - Street 2:
Practice Address - City:NORTH FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02556-2841
Practice Address - Country:US
Practice Address - Phone:508-560-2550
Practice Address - Fax:508-563-2570
Is Sole Proprietor?:No
Enumeration Date:2015-05-05
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA8110363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1125635OtherNCCPA
MDC06181OtherMARYLAND PHYSICIAN ASSISTANT LICENSE
1125635OtherNCCPA