Healthcare Provider Details

I. General information

NPI: 1619914322
Provider Name (Legal Business Name): JOHN A CAVALLO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 04/09/2024
Certification Date: 04/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 DONALD'S WAY STE 200
EAST BRIDGEWATER MA
02333-1464
US

IV. Provider business mailing address

1 COMPASS WAY STE 200
E BRIDGEWATER MA
02333-1464
US

V. Phone/Fax

Practice location:
  • Phone: 508-940-0400
  • Fax: 508-894-0412
Mailing address:
  • Phone: 508-697-3677
  • Fax: 508-894-0412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number158340
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: