Healthcare Provider Details

I. General information

NPI: 1164572418
Provider Name (Legal Business Name): MARISSA R CAULEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARISSA R NEWTON PA-C

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 04/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS ST BRIGHAM AND WOMEN'S HOSPITAL
BOSTON MA
02115
US

IV. Provider business mailing address

30A CAUSEWAY ST
MEDWAY MA
02053-2419
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-5500
  • Fax:
Mailing address:
  • Phone: 617-513-9903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA2241
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number2241
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: