Provider Demographics
NPI:1457341315
Name:CAHILL, MICHELLE (PAC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:CAHILL
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:MCCABE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:75 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-1795
Mailing Address - Country:US
Mailing Address - Phone:781-585-2200
Mailing Address - Fax:781-585-1784
Practice Address - Street 1:5 TARKILN RD
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:MA
Practice Address - Zip Code:02364-1250
Practice Address - Country:US
Practice Address - Phone:781-585-2200
Practice Address - Fax:781-585-1784
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA262363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA042297845OtherTRICARE
MA042297845OtherDOC FIRST
MA042297845OtherGREAT WEST HEALTH CARE
042297845OtherPHCS/MULTI-PLAN
MA54836OtherFALLON
042297845OtherPHCS/MULTI-PLAN
MACAAP1719Medicare ID - Type Unspecified