Basic Information
| Provider Information | |||||||||
| NPI: | 1871140178 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CAHILL | ||||||||
| FirstName: | SAMUEL | ||||||||
| MiddleName: | JOSEPH | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 181 NORTH ST | ||||||||
| Address2: | |||||||||
| City: | NEW HAVEN | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054722007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2089189911 | ||||||||
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| Practice Location | |||||||||
| Address1: | 275 ROUTE 30 N | ||||||||
| Address2: | |||||||||
| City: | BOMOSEEN | ||||||||
| State: | VT | ||||||||
| PostalCode: | 057329647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8024685641 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2019 | ||||||||
| LastUpdateDate: | 08/16/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 6706827 | 05 | VT | MEDICAID |