Basic Information
| Provider Information | |||||||||
| NPI: | 1023081841 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CATTEL | ||||||||
| FirstName: | PAMELA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 409 W BROADWAY | ||||||||
| Address2: | |||||||||
| City: | SOUTH BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021272245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6172697500 | ||||||||
| FaxNumber: | 6174647512 | ||||||||
| Practice Location | |||||||||
| Address1: | 409 W BROADWAY | ||||||||
| Address2: | |||||||||
| City: | SOUTH BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021272245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6172697500 | ||||||||
| FaxNumber: | 6174647512 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2006 | ||||||||
| LastUpdateDate: | 02/09/2012 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 77698 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | J13912 | 01 | MA | BLUE CROSS | OTHER | 077698 | 01 | MA | TUFTS HEALTH PLAN | OTHER | 077698 | 01 | MA | SECURE HORIZONS | OTHER | 000000008300 | 01 | MA | BMC HEALTHNET | OTHER | 61964UH | 01 | MA | HARVARD PILGRIM | OTHER | 0001131 | 01 | MA | NEIGHBORHOOD HEALTH PLAN | OTHER |