Provider Demographics
NPI:1093705816
Name:CHEVALIER, CARA L (MD)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:L
Last Name:CHEVALIER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CARA
Other - Middle Name:LEE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:178 SAVIN STREET
Mailing Address - Street 2:HALLMARK HEALTH MEDICAL ASSOCIATES-FAMILY HEALTH CENTER
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148
Mailing Address - Country:US
Mailing Address - Phone:781-338-7400
Mailing Address - Fax:781-388-7405
Practice Address - Street 1:178 SAVIN STREET
Practice Address - Street 2:HALLMARK HEALTH MEDICAL ASSOCIATES-FAMILY HEALTH CENTER
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148
Practice Address - Country:US
Practice Address - Phone:781-338-7400
Practice Address - Fax:781-338-7405
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA224119207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2109239Medicaid
MA2109239Medicaid
MAA38950Medicare PIN