Provider Demographics
NPI:1770692782
Name:EMMONS, WESLEY W (MD)
Entity type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:W
Last Name:EMMONS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:537 STANTON CHRISTIANA RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2146
Mailing Address - Country:US
Mailing Address - Phone:302-994-9692
Mailing Address - Fax:302-994-9803
Practice Address - Street 1:537 STANTON CHRISTIANA RD
Practice Address - Street 2:SUITE 201
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2146
Practice Address - Country:US
Practice Address - Phone:302-994-9692
Practice Address - Fax:302-994-9803
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10002931207RI0200X
MDD0060900207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0001113001Medicaid
DEP00017869OtherRAILROAD MEDICARE
DEP00017869OtherRAILROAD MEDICARE
MD049MK142Medicare ID - Type Unspecified
DE012142I60Medicare ID - Type Unspecified