Provider Demographics
NPI:1265846331
Name:MUSSHORN, EMMA LOUISE (MD)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:LOUISE
Last Name:MUSSHORN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:LOUISE
Other - Last Name:CHIPMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1925 GLENN MITCHELL DR STE 100
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-0170
Mailing Address - Country:US
Mailing Address - Phone:757-689-8430
Mailing Address - Fax:757-689-8435
Practice Address - Street 1:10715 LITTLE PATUXENT PKWY STE 100-B
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3123
Practice Address - Country:US
Practice Address - Phone:443-917-6647
Practice Address - Fax:443-917-6648
Is Sole Proprietor?:No
Enumeration Date:2014-06-17
Last Update Date:2025-11-06
Deactivation Date:2015-01-20
Deactivation Code:
Reactivation Date:2015-02-03
Provider Licenses
StateLicense IDTaxonomies
VA0101273111207Q00000X
MDD0101798207Q00000X
NH18021207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3109061Medicaid