Individual
DR. EMILIE PETULA TIBEMEN BIONDOKIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
195 CANAL ST, MALDEN, MA 02148-6701
(781) 338-0500
Mailing address
815 THAYER AVE APT 1432, SILVER SPRING, MD 20910-5702
(240) 416-8496
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
D94898
MD
390200000X
Student in an Organized Health Care Education/Training Program
271780
MA
Other
Enumeration date
05/02/2017
Last updated
09/06/2022
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