Provider Demographics
NPI:1235312448
Name:TACK, EMILIE A (DO)
Entity type:Individual
Prefix:DR
First Name:EMILIE
Middle Name:A
Last Name:TACK
Suffix:
Gender:
Credentials:DO
Other - Prefix:DR
Other - First Name:EMILIE
Other - Middle Name:
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:960 MASSACHUSETTS AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2690
Mailing Address - Country:US
Mailing Address - Phone:617-414-4505
Mailing Address - Fax:781-255-0774
Practice Address - Street 1:830 OAK ST STE 124E
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1192
Practice Address - Country:US
Practice Address - Phone:508-897-4730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-11
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101017260207V00000X
MA246375207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology