Healthcare Provider Details

I. General information

NPI: 1255394904
Provider Name (Legal Business Name): JOHANNA B CAHILL PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 03/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 SEYMOUR ST STE 719
HARTFORD CT
06106-5560
US

IV. Provider business mailing address

85 SEYMOUR ST STE 719
HARTFORD CT
06106-5560
US

V. Phone/Fax

Practice location:
  • Phone: 860-522-0604
  • Fax: 860-247-0422
Mailing address:
  • Phone: 860-522-0604
  • Fax: 860-247-0422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001667
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: