Provider Demographics
NPI:1447782412
Name:FARRELL, CAITLIN M (DO)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:M
Last Name:FARRELL
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:960 MASSACHUSETTS AVENUE
Mailing Address - Street 2:FL 2
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2690
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 BOSTON MEDICAL CENTER PLACE
Practice Address - Street 2:BCD 1ST FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-0211
Practice Address - Country:US
Practice Address - Phone:617-414-5481
Practice Address - Fax:617-414-7759
Is Sole Proprietor?:No
Enumeration Date:2017-03-29
Last Update Date:2023-06-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA291461207P00000X
MA280826390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3137735Medicaid
MA110154536AMedicaid