Provider Demographics
NPI:1255367652
Name:KONSTAN, EMILY CATHERINE
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:CATHERINE
Last Name:KONSTAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 ALEXANDER AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-6203
Mailing Address - Country:US
Mailing Address - Phone:781-306-0515
Mailing Address - Fax:
Practice Address - Street 1:11 ALEXANDER AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-6203
Practice Address - Country:US
Practice Address - Phone:781-306-0515
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist