Healthcare Provider Details

I. General information

NPI: 1871140178
Provider Name (Legal Business Name): SAMUEL JOSEPH CAHILL PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2019
Last Update Date: 08/16/2021
Certification Date: 08/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 ROUTE 30 N
BOMOSEEN VT
05732-9647
US

IV. Provider business mailing address

181 NORTH ST
NEW HAVEN VT
05472-2007
US

V. Phone/Fax

Practice location:
  • Phone: 802-468-5641
  • Fax:
Mailing address:
  • Phone: 208-918-9911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: