1417935214 NPI number — TERESA R CAHILL MD

Table of content: TERESA R CAHILL MD (NPI 1417935214)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417935214 NPI number — TERESA R CAHILL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAHILL
Provider First Name:
TERESA
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417935214
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 66799
Provider Second Line Business Mailing Address:
NEWTON WELLESLEY RADIOLOGY ASSOCIATES
Provider Business Mailing Address City Name:
FALMOUTH
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04105-6799
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-347-7423
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2014 WASHINGTON ST
Provider Second Line Business Practice Location Address:
NEWTON WELLESLEY RADIOLOGY ASSOCIATES
Provider Business Practice Location Address City Name:
NEWTON LOWER FALLS
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02462-1607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-243-6600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/03/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085B0100X , with the licence number:  72359 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: J12171 . This is a "BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 3089321 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".