Basic Information
| Provider Information | |||||||||
| NPI: | 1093705816 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHEVALIER | ||||||||
| FirstName: | CARA | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SMITH | ||||||||
| OtherFirstName: | CARA | ||||||||
| OtherMiddleName: | LEE | ||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 178 SAVIN STREET | ||||||||
| Address2: | HALLMARK HEALTH MEDICAL ASSOCIATES-FAMILY HEALTH CENTER | ||||||||
| City: | MALDEN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7813387400 | ||||||||
| FaxNumber: | 7813887405 | ||||||||
| Practice Location | |||||||||
| Address1: | 178 SAVIN STREET | ||||||||
| Address2: | HALLMARK HEALTH MEDICAL ASSOCIATES-FAMILY HEALTH CENTER | ||||||||
| City: | MALDEN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7813387400 | ||||||||
| FaxNumber: | 7813387405 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2005 | ||||||||
| LastUpdateDate: | 04/27/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 224119 | MA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2109239 | 05 | MA | MEDICAID |