Provider Demographics
NPI:1659331916
Name:CAVANAUGH, ROBERT J (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:CAVANAUGH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:630 PLANTATION ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605
Mailing Address - Country:US
Mailing Address - Phone:508-865-5858
Mailing Address - Fax:508-581-0070
Practice Address - Street 1:94 ELM ST
Practice Address - Street 2:
Practice Address - City:MILLBURY
Practice Address - State:MA
Practice Address - Zip Code:01527
Practice Address - Country:US
Practice Address - Phone:508-865-5858
Practice Address - Fax:508-581-0070
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2009-01-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA35867207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1059663OtherFIRST HEALTH
AA1297OtherHARVARD PILGRIM HEALTHCAR
042472266OtherONE HEALTH PLAN
110221136OtherRAILROAD MEDICARE
26787OtherHEALTHY START
E33011OtherBLUE SHIELD HMO BLUE
043058466OtherHEALTHCARE VALUE MGMT
E33011OtherBLUE CARE ELECT
0402099OtherEVERCARE
E33011OtherMEDICARE B
042472266OtherTHREE RIVERS
26787OtherCHILDRENS MED SEC PLAN
3289040OtherCIGNA HEALTH PLAN
042472266OtherPRIVATE HEALTHCARE SYSTEM
MA3099059Medicaid
784249OtherMVP HEALTH CARE
E33011OtherBLUE SHIELD INDEMNITY
2634567OtherAETNA US HEALTHCARE
042472266OtherTHREE RIVERS
AA1297OtherHARVARD PILGRIM HEALTHCAR