Provider Demographics
NPI:1578597456
Name:CAVAGNARO, CHARLES E III (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:E
Last Name:CAVAGNARO
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:SOUTHBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01550-0040
Mailing Address - Country:US
Mailing Address - Phone:508-909-7799
Mailing Address - Fax:
Practice Address - Street 1:255 E OLD STURBRIDGE RD
Practice Address - Street 2:
Practice Address - City:BRIMFIELD
Practice Address - State:MA
Practice Address - Zip Code:01010-9647
Practice Address - Country:US
Practice Address - Phone:413-245-3389
Practice Address - Fax:413-245-4553
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA52186207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
052186OtherCONNECTICARE
65351OtherHARVARD PILGRIM
J03714OtherBLUE CROSS/BLUE SHIELD
19675OtherFALLON COMMUNITY HEALTH
J03714Medicare ID - Type Unspecified
0401557OtherUNITED HEALTH CARE
052186OtherTUFTS COMMUNITY HEALTH
4390323OtherHEALTHCOURCE CMHC
B74413Medicare UPIN
984943OtherNETWORK HEALTH
MA6179584Medicaid
100196OtherCIGNA
110123293OtherRAILROAD MEDICARE