Provider Demographics
NPI:1265400766
Name:CABANISS, PATRICIA SUSAN (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:SUSAN
Last Name:CABANISS
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 1:1619 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-3515
Mailing Address - Country:US
Mailing Address - Phone:304-428-1889
Mailing Address - Fax:
Practice Address - Street 1:600 18TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-3231
Practice Address - Country:US
Practice Address - Phone:304-424-4751
Practice Address - Fax:304-424-4753
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV17852207V00000X
CAG64535207V00000X
OH67635207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0994974OtherOHIO MEDICAID ID
WVE91901Medicare UPIN
WV0766641Medicare ID - Type Unspecified