Provider Demographics
NPI:1891255113
Name:ABBOOD, EMILY ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ANN
Last Name:ABBOOD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1351 S COUNTY TRL STE 303
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-5083
Mailing Address - Country:US
Mailing Address - Phone:401-885-8484
Mailing Address - Fax:
Practice Address - Street 1:1351 S COUNTY TRL STE 303
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-5083
Practice Address - Country:US
Practice Address - Phone:401-885-8484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-22
Last Update Date:2020-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA01113363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant