Provider Demographics
NPI:1710185624
Name:CAVALLO, JAIME ANN (MD, MPHS)
Entity Type:Individual
Prefix:DR
First Name:JAIME
Middle Name:ANN
Last Name:CAVALLO
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Gender:F
Credentials:MD, MPHS
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Mailing Address - Street 1:789 HOWARD AVENUE
Mailing Address - Street 2:UROLOGY SUITE, FMP 300
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519
Mailing Address - Country:US
Mailing Address - Phone:203-785-5339
Mailing Address - Fax:203-785-4043
Practice Address - Street 1:789 HOWARD AVENUE
Practice Address - Street 2:UROLOGY SUITE, FMP 300
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519
Practice Address - Country:US
Practice Address - Phone:203-785-5339
Practice Address - Fax:203-785-4043
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2019-08-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2007016879208600000X
MA273672208800000X
NY291812-1208800000X
CT63683208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No208600000XAllopathic & Osteopathic PhysiciansSurgery