1003065905 NPI number — DR. CLIFFORD QUINN CABANSAG MD

Table of content: DR. CLIFFORD QUINN CABANSAG MD (NPI 1003065905)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003065905 NPI number — DR. CLIFFORD QUINN CABANSAG MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CABANSAG
Provider First Name:
CLIFFORD
Provider Middle Name:
QUINN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CABANSAG
Provider Other First Name:
CLIFF
Provider Other Middle Name:
QUINN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1003065905
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4302 ROOSEVELT BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDDLETOWN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45044-6697
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-433-1032
Provider Business Mailing Address Fax Number:
513-433-1245

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4302 ROOSEVELT BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLETOWN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45044-6697
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-433-1032
Provider Business Practice Location Address Fax Number:
513-433-1245
Provider Enumeration Date:
09/16/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RA0401X , with the licence number:  35.099392 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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