Healthcare Provider Details

I. General information

NPI: 1144346537
Provider Name (Legal Business Name): CYNTHIA MCKALLAGAT CFM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

349 N MAIN ST
ANDOVER MA
01810-2687
US

IV. Provider business mailing address

39 FERNWOOD AVE
HAVERHILL MA
01835-8153
US

V. Phone/Fax

Practice location:
  • Phone: 978-475-7779
  • Fax: 978-475-1662
Mailing address:
  • Phone: 978-521-1492
  • Fax: 978-475-1662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberCFM01485
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: