Basic Information
| Provider Information | |||||||||
| NPI: | 1306836093 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCAULEY | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2000 PERIMETER PARK DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | MORRISVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275608442 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 118 KNOX WAY | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275166610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9842155900 | ||||||||
| FaxNumber: | 9842155942 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2005 | ||||||||
| LastUpdateDate: | 05/11/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 2018-01071 | NC | N | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | 207692 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | 207692 | MA | N | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | 2018-01071 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 207692 | 01 | MA | TUFTS HEALTH PLAN | OTHER | 0192988 | 05 | MA | MEDICAID | J24735 | 01 | MA | BCBS MA | OTHER |