Healthcare Provider Details

I. General information

NPI: 1588273338
Provider Name (Legal Business Name): CONOR DANIEL CAHALAN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2020
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 14TH AVE PO BOX 537
SKAGWAY AK
99840-0537
US

IV. Provider business mailing address

PO BOX 537
SKAGWAY AK
99840-0537
US

V. Phone/Fax

Practice location:
  • Phone: 907-983-2255
  • Fax: 907-983-2793
Mailing address:
  • Phone: 907-983-2255
  • Fax: 907-983-2793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number91400
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number161091
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: