MEDICARE: BENJAMIN MICHAEL CABRAL PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	AP2148	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AP2148	OTHER	MA	STATE LICENSE

General Provider Information

NPI Number	:	1194756650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN MICHAEL CABRAL PA-C

Provider Business Mailing Address
First Line	:	54 RAILROAD AVE
Second Line	:
City	:	NORWOOD
State	:	MA
Zip	:	02062-4226
Country	:	US
Telephone Number	:	781-769-2438
Fax Number	:

Provider Business Practice Location Address
First Line	:	31 FOREST ST
Second Line	:
City	:	NEWTON HIGHLANDS
State	:	MA
Zip	:	02461-1445
Country	:	US
Telephone Number	:	617-916-1300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	03/01/2009

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