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NPI Code Detail

MEDICARE: DR. JUSTIN PATHICKAL D.O.

MEDICARE: DR. JUSTIN PATHICKAL D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine Physician1016319MA
2207Q00000XFamily Medicine Physician294185NY
3207P00000XEmergency Medicine PhysicianDO01283RI
4207P00000XEmergency Medicine Physician294185NY

General Provider Information

NPI Number : 1528440054
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JUSTIN PATHICKAL D.O.
Provider Business Mailing Address
First Line : 81 HIGHLAND AVE
Second Line :
City : SALEM
State : MA
Zip : 01970-2768
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 81 HIGHLAND AVE
Second Line :
City : SALEM
State : MA
Zip : 01970-2768
Country : US
Telephone Number : 978-741-1200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2015
Last Update Date : 10/20/2025

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Directions to “ DR. JUSTIN PATHICKAL D.O.” Practice Location

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