Healthcare Provider Details

I. General information

NPI: 1073566410
Provider Name (Legal Business Name): CAPE COD PAIN MANAGEMENT, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 N MAIN ST
CARVER MA
02330
US

IV. Provider business mailing address

68 N MAIN ST
CARVER MA
02330-1128
US

V. Phone/Fax

Practice location:
  • Phone: 508-747-7246
  • Fax: 508-747-7256
Mailing address:
  • Phone: 508-747-7246
  • Fax: 508-747-7256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number StateMA

VIII. Authorized Official

Name: DR. DAVID GANNON
Title or Position: PRESIDENT
Credential: MD
Phone: 508-747-7246