Provider Demographics
NPI:1033177050
Name:CAVALLI, VICTORIA R (MD)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:R
Last Name:CAVALLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 HOSPITAL AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:NORTH ADAMS
Mailing Address - State:MA
Mailing Address - Zip Code:01247-2538
Mailing Address - Country:US
Mailing Address - Phone:413-663-6769
Mailing Address - Fax:
Practice Address - Street 1:77 HOSPITAL AVE STE 200
Practice Address - Street 2:
Practice Address - City:NORTH ADAMS
Practice Address - State:MA
Practice Address - Zip Code:01247-2538
Practice Address - Country:US
Practice Address - Phone:413-663-6769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA154221207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
M21331Medicare PIN