Provider Demographics
NPI:1134419310
Name:WESTERMANN-CLARK, EMMA (MD)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:WESTERMANN-CLARK
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:
Other - Last Name:WESTERMANN SHAH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3210 COVE BEND DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-2752
Mailing Address - Country:US
Mailing Address - Phone:813-869-7111
Mailing Address - Fax:813-706-6126
Practice Address - Street 1:3210 COVE BEND DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-2752
Practice Address - Country:US
Practice Address - Phone:813-869-7111
Practice Address - Fax:813-706-6126
Is Sole Proprietor?:No
Enumeration Date:2011-04-08
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME120465207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014511700Medicaid
FL14X80OtherBLUE CROSS BLUE SHIELD