Provider Demographics
NPI:1821082660
Name:MASSICOTTE, EMMA (MD)
Entity Type:Individual
Prefix:DR
First Name:EMMA
Middle Name:
Last Name:MASSICOTTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:195 SCHOOL ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MANCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01944-1700
Mailing Address - Country:US
Mailing Address - Phone:978-526-4800
Mailing Address - Fax:978-526-7179
Practice Address - Street 1:195 SCHOOL ST
Practice Address - Street 2:SUITE B
Practice Address - City:MANCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01944-1700
Practice Address - Country:US
Practice Address - Phone:978-526-4800
Practice Address - Fax:978-526-7179
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2010-05-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA218964207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2021196Medicaid
M15433Medicare PIN
H91583Medicare UPIN