Healthcare Provider Details

I. General information

NPI: 1093464562
Provider Name (Legal Business Name): BONNIE CAHILL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 VETERANS MEMORIAL PKWY # 15B
EAST PROVIDENCE RI
02914-5300
US

IV. Provider business mailing address

38 CAPTAIN JOHN JACOBS RD APT 208
EAST PROVIDENCE RI
02914-5383
US

V. Phone/Fax

Practice location:
  • Phone: 401-434-3350
  • Fax: 401-434-5230
Mailing address:
  • Phone: 315-935-5753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA01657
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number029127
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: