Provider Demographics
NPI:1336357805
Name:PROFESSIONAL MEDICAL ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:PROFESSIONAL MEDICAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:HARRY
Authorized Official - Last Name:CAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-524-4431
Mailing Address - Street 1:1155 CENTRE ST
Mailing Address - Street 2:SUITE 5985
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-3432
Mailing Address - Country:US
Mailing Address - Phone:617-524-4431
Mailing Address - Fax:617-983-7533
Practice Address - Street 1:1155 CENTRE ST
Practice Address - Street 2:SUITE 5985
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-3432
Practice Address - Country:US
Practice Address - Phone:617-524-4431
Practice Address - Fax:617-983-7533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA38918207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA038918OtherTUFTS
MA10006OtherHARVARD PILGRIM
MA2060507Medicaid
MA2060507Medicaid
MAA66994Medicare UPIN