Basic Information
| Provider Information | |||||||||
| NPI: | 1639257892 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EMMETT | ||||||||
| FirstName: | GARY | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 191 | ||||||||
| Address2: | |||||||||
| City: | ROCKLAND | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197320191 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026514000 | ||||||||
| FaxNumber: | 3026514945 | ||||||||
| Practice Location | |||||||||
| Address1: | 833 CHESTNUT STREET EAST, SUITE 300 | ||||||||
| Address2: | JEFFERSON FACULTY PEDS AND DUPONT CHILDRENS HLTH PROG | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191074405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2158618800 | ||||||||
| FaxNumber: | 2158618815 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2006 | ||||||||
| LastUpdateDate: | 02/20/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | MD019420E | PA | N | Allopathic & Osteopathic Physicians | Pediatrics | 208D00000X | MD019420E | PA | N | Allopathic & Osteopathic Physicians | General Practice | 208M00000X | MD019420E | PA | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 7507801 | 05 | NJ | MEDICAID | 763949 | 05 | PA | MEDICAID | 4104382 | 05 | MD | MEDICAID |