Provider Demographics
NPI:1730187212
Name:CAINE, JONATHAN L (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:L
Last Name:CAINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 MORSE ST
Mailing Address - Street 2:2ND FLOOR WEST
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-4679
Mailing Address - Country:US
Mailing Address - Phone:781-769-4090
Mailing Address - Fax:781-769-6485
Practice Address - Street 1:100 MORSE ST
Practice Address - Street 2:2ND FLOOR WEST
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-4679
Practice Address - Country:US
Practice Address - Phone:781-769-4090
Practice Address - Fax:781-769-6485
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA57848208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110051102AMedicaid
MAD64597Medicare UPIN