Provider Demographics
NPI:1053769596
Name:EASTMAN, EMMANUELLA MARIA (DPM)
Entity type:Individual
Prefix:
First Name:EMMANUELLA
Middle Name:MARIA
Last Name:EASTMAN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 825159
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-5159
Mailing Address - Country:US
Mailing Address - Phone:314-909-1920
Mailing Address - Fax:855-495-2106
Practice Address - Street 1:15215 SHADY GROVE RD STE 307
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-0202
Practice Address - Country:US
Practice Address - Phone:240-268-7450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-25
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01666213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery