Healthcare Provider Details

I. General information

NPI: 1134266885
Provider Name (Legal Business Name): MADELYNN AZAR-CAVANAGH MD, MPH, CPE, FACOEM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 07/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE MEDICAL CENTER DRIVE DARTMOUTH HITCHCOCK - OCCUPATIONAL MEDICINE
LEBANON NH
03756
US

IV. Provider business mailing address

24 BRADFORD ST APT 2
BOSTON MA
02118-2119
US

V. Phone/Fax

Practice location:
  • Phone: 603-653-3893
  • Fax:
Mailing address:
  • Phone: 646-799-8944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number272637
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberLT4099
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: