Individual
EMMA F FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
840 HARRISON AVE, BOSTON, MA 02118
(617) 638-6610
(617) 638-6616
Mailing address
960 MASSACHUSETTS AVE, FL2, BOSTON, MA 02118-2690
(617) 414-5405
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110215109A
—
MA
05
—
3148439
—
NH
Enumeration date
09/10/2024
Last updated
01/21/2026
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