Provider Demographics
NPI:1740256395
Name:ACKERMAN, EMILY JANE (MD)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:JANE
Last Name:ACKERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:J
Other - Last Name:HILE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 927
Mailing Address - Street 2:
Mailing Address - City:SLATERSVILLE
Mailing Address - State:RI
Mailing Address - Zip Code:02876
Mailing Address - Country:US
Mailing Address - Phone:401-597-5656
Mailing Address - Fax:401-597-5671
Practice Address - Street 1:261 MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:SLATERSVILLE
Practice Address - State:RI
Practice Address - Zip Code:02876-1015
Practice Address - Country:US
Practice Address - Phone:401-597-5656
Practice Address - Fax:401-597-5671
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI07Q00000X207Q00000X
RIMD11830207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIMD11830OtherLICENSE