Provider Demographics
NPI:1881682466
Name:CACCIOLA, EUGENE JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:JOHN
Last Name:CACCIOLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1863 BEACON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-4270
Mailing Address - Country:US
Mailing Address - Phone:617-734-5130
Mailing Address - Fax:617-566-7831
Practice Address - Street 1:1863 BEACON ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-4270
Practice Address - Country:US
Practice Address - Phone:617-734-5130
Practice Address - Fax:617-566-7831
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-08
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA395722084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAC04756Medicare UPIN