Provider Demographics
NPI:1134266885
Name:AZAR-CAVANAGH, MADELYNN (MD, MPH, CPE, FACOEM)
Entity type:Individual
Prefix:DR
First Name:MADELYNN
Middle Name:
Last Name:AZAR-CAVANAGH
Suffix:
Gender:F
Credentials:MD, MPH, CPE, FACOEM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 BRADFORD ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2119
Mailing Address - Country:US
Mailing Address - Phone:646-799-8944
Mailing Address - Fax:
Practice Address - Street 1:ONE MEDICAL CENTER DRIVE
Practice Address - Street 2:DARTMOUTH HITCHCOCK - OCCUPATIONAL MEDICINE
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03756
Practice Address - Country:US
Practice Address - Phone:603-653-3893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2726372083X0100X
NHLT40992083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA60134OtherSTATE OF MASSACHUSETTS PHYSICIAN LICENCE
CAG64777OtherSTATE OF CALIFORNIA PHYSICIAN LICENSE
NHLT-4099OtherSTATE OF NEW HAMPSHIRE LOCUM TENENS LICENSE
NY272537-1OtherSTATE OF NEW YORK PHYSICIAN LICENSE