Provider Demographics
NPI:1033193032
Name:CAVANAUGH, RAYMOND ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:ROBERT
Last Name:CAVANAUGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 LONGVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MARBLEHEAD
Mailing Address - State:MA
Mailing Address - Zip Code:01945-1163
Mailing Address - Country:US
Mailing Address - Phone:978-764-5807
Mailing Address - Fax:978-354-5026
Practice Address - Street 1:10 FEDERAL ST
Practice Address - Street 2:SUITE 408
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-3860
Practice Address - Country:US
Practice Address - Phone:978-354-5021
Practice Address - Fax:978-354-5026
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-02
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA486022084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0157937Medicaid
L02017Medicare ID - Type Unspecified
L02017Medicare UPIN