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NPI Code Detail

MEDICARE: DR. JACQUELYN CAWLEY DO

MEDICARE: DR. JACQUELYN CAWLEY DO
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
1207Q00000XFamily Medicine Physician1415ME

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1346299146
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JACQUELYN CAWLEY DO
Provider Business Mailing Address
First Line : 301 US ROUTE 1
Second Line : BUILDING C
City : SCARBOROUGH
State : ME
Zip : 04074-7609
Country : US
Telephone Number : 207-396-8600
Fax Number : 207-396-8632
Provider Business Practice Location Address
First Line : 272 CONGRESS ST
Second Line :
City : PORTLAND
State : ME
Zip : 04101-3637
Country : US
Telephone Number : 207-874-2466
Fax Number : 207-774-4625
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/09/2006
Last Update Date : 11/26/2014

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