Healthcare Provider Details

I. General information

NPI: 1588696017
Provider Name (Legal Business Name): VICTOR J CILLIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 INDEPENDENCE DR
HYANNIS MA
02601-1898
US

IV. Provider business mailing address

100 INDEPENDENCE DR
HYANNIS MA
02601-1898
US

V. Phone/Fax

Practice location:
  • Phone: 508-775-8687
  • Fax:
Mailing address:
  • Phone: 508-775-8687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number77838
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: