Provider Demographics
NPI:1275524571
Name:CARGILL, KARYL COLETTI (CNM)
Entity Type:Individual
Prefix:
First Name:KARYL
Middle Name:COLETTI
Last Name:CARGILL
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:30 NEWCROSSING RD
Mailing Address - Street 2:ELL POND MEDICAL ASSOCIATES
Mailing Address - City:READING
Mailing Address - State:MA
Mailing Address - Zip Code:01867-3270
Mailing Address - Country:US
Mailing Address - Phone:781-246-3500
Mailing Address - Fax:781-246-3555
Practice Address - Street 1:30 NEWCROSSING RD
Practice Address - Street 2:ELL POND MEDICAL ASSOCIATES
Practice Address - City:READING
Practice Address - State:MA
Practice Address - Zip Code:01867-3270
Practice Address - Country:US
Practice Address - Phone:781-246-3500
Practice Address - Fax:781-246-3555
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA138203367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0357448Medicaid
R34485Medicare UPIN
MA0357448Medicaid