Provider Demographics
NPI:1952373193
Name:LACHIATTO, EMILY B (PA)
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:B
Last Name:LACHIATTO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:B
Other - Last Name:WARREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA C
Mailing Address - Street 1:PO BOX 391
Mailing Address - Street 2:INNOVATIVE PHYSICIAN SERVICES LLC
Mailing Address - City:WILBRAHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01095-0391
Mailing Address - Country:US
Mailing Address - Phone:508-595-0531
Mailing Address - Fax:508-829-5367
Practice Address - Street 1:189 MAY ST
Practice Address - Street 2:INNOVATIVE PHYSICIAN SERVICES LLC
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01602
Practice Address - Country:US
Practice Address - Phone:508-791-6351
Practice Address - Fax:508-753-2087
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1637363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AP2106Medicare ID - Type Unspecified
Q16261Medicare UPIN