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NPI Code Detail

MEDICARE: CECILIA DOUR O'MALLEY NP

MEDICARE:   CECILIA DOUR O'MALLEY  NP
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
1363L00000XNurse Practitioner122696MA

General Provider Information

NPI Number : 1467541698
Entity Type Code : Individual
Provider Name (Legal Business Name) : CECILIA DOUR O'MALLEY NP
Provider Business Mailing Address
First Line : 105 CAPEN ST
Second Line :
City : MILTON
State : MA
Zip : 02186-1709
Country : US
Telephone Number : 617-698-0091
Fax Number :
Provider Business Practice Location Address
First Line : 3297 WASHINGTON ST
Second Line :
City : JAMAICA PLAIN
State : MA
Zip : 02130-2655
Country : US
Telephone Number : 617-522-4700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2006
Last Update Date : 07/08/2007

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Directions to “ CECILIA DOUR O'MALLEY NP” Practice Location

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