Basic Information
| Provider Information | |||||||||
| NPI: | 1174649750 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAGANDA | ||||||||
| FirstName: | ROBERTO ELIAS | ||||||||
| MiddleName: | MADARA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CAGANDA | ||||||||
| OtherFirstName: | ROEL | ||||||||
| OtherMiddleName: | MADARA | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 151 EVERETT AVE | ||||||||
| Address2: | MGH CHELSEA HEALTH CENTER - URGENT CARE | ||||||||
| City: | CHELSEA | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021501812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6178848302 | ||||||||
| FaxNumber: | 6178873704 | ||||||||
| Practice Location | |||||||||
| Address1: | 151 EVERETT AVE | ||||||||
| Address2: | MGH CHELSEA HEALTH CENTER - URGENT CARE | ||||||||
| City: | CHELSEA | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021501812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6178848302 | ||||||||
| FaxNumber: | 6178873704 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2007 | ||||||||
| LastUpdateDate: | 09/06/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | C7-0003033 | DE | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 036119315 | IL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 238012 | MA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.