Provider Demographics
NPI:1578396230
Name:EMPALLO MEDICAL GROUP, P.A.
Entity type:Organization
Organization Name:EMPALLO MEDICAL GROUP, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISSHAAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-459-8899
Mailing Address - Street 1:160 CAMBRIDGEPARK DR UNIT 112
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-2452
Mailing Address - Country:US
Mailing Address - Phone:617-798-7897
Mailing Address - Fax:
Practice Address - Street 1:160 CAMBRIDGEPARK DR UNIT 112
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02140-2452
Practice Address - Country:US
Practice Address - Phone:617-798-7897
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-20
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RA0001XAllopathic & Osteopathic PhysiciansInternal MedicineAdvanced Heart Failure and Transplant CardiologyGroup - Multi-Specialty