Provider Demographics
NPI:1144480740
Name:MCAULEY, NICHOLAS DAVID (MD)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:DAVID
Last Name:MCAULEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:330 BAKER AVE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-2129
Mailing Address - Country:US
Mailing Address - Phone:978-287-9350
Mailing Address - Fax:978-287-9356
Practice Address - Street 1:330 BAKER AVE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2129
Practice Address - Country:US
Practice Address - Phone:978-287-9350
Practice Address - Fax:978-287-9356
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA241814207RS0010X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1144480740OtherEVERCARE
MA1144480740OtherBLUE CROSS BLUE SHIELD
MA1144480740OtherFALLON COMMUNITY HEALTH PLAN
MA1144480740OtherCIGNA
MA0458394OtherNEIGHBORHOOD HEALTH PLAN
MA1144480740OtherAETNA HMO
MAP00920437OtherRAILROAD MEDICARE
NH1144480740OtherANTHEM BS
MA949131-02OtherNETWORK
MA9420356OtherAAETNA NON HMO
MA110083762AMedicaid
NH30208911Medicaid
MAAA152962OtherHARVARD PILGRIM
MA753502OtherTUFTS HEALTH PLAN
MAJ46112OtherBCBS
MA1144480740OtherFALLON COMMUNITY HEALTH PLAN