Provider Demographics
NPI:1619914322
Name:CAVALLO, JOHN A (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:CAVALLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1 COMPASS WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:E BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02333-1464
Mailing Address - Country:US
Mailing Address - Phone:508-697-3677
Mailing Address - Fax:508-894-0412
Practice Address - Street 1:1 DONALD'S WAY STE 200
Practice Address - Street 2:
Practice Address - City:EAST BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02333-1464
Practice Address - Country:US
Practice Address - Phone:508-940-0400
Practice Address - Fax:508-894-0412
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA158340207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2020289Medicaid
MA6000556OtherHPHC
MAJ26823OtherBC/BS
MA219229OtherTAHP
MAA36184OtherMEDICARE
MA2020289Medicaid