Provider Demographics
NPI:1518908839
Name:CARDINALE, KATHLEEN (PA)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:CARDINALE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 WHITE ST
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-1976
Mailing Address - Country:US
Mailing Address - Phone:617-489-4007
Mailing Address - Fax:617-484-5407
Practice Address - Street 1:43 WHITE ST
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478-1976
Practice Address - Country:US
Practice Address - Phone:617-489-4007
Practice Address - Fax:617-484-5407
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA209363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAP1087Medicare ID - Type Unspecified
MAS85624Medicare UPIN