Provider Demographics
NPI:1861854283
Name:CAVALLO, GINA M (MD)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:M
Last Name:CAVALLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 MADISON AVE FL 5
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-7354
Mailing Address - Country:US
Mailing Address - Phone:973-540-9700
Mailing Address - Fax:
Practice Address - Street 1:65 MADISON AVE FL 5
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-7354
Practice Address - Country:US
Practice Address - Phone:973-540-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-24
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA118631002086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery