Provider Demographics
NPI:1295796423
Name:FLORES CARDILLO, JOSE ROBERTO (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:ROBERTO
Last Name:FLORES CARDILLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01721-1187
Mailing Address - Country:US
Mailing Address - Phone:508-881-3029
Mailing Address - Fax:508-881-1752
Practice Address - Street 1:246 MAPLE ST STE 3
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-3235
Practice Address - Country:US
Practice Address - Phone:508-787-3482
Practice Address - Fax:508-485-5298
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA81513207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3146839Medicaid
A21035Medicare ID - Type Unspecified
MA3146839Medicaid