1316929540 NPI number — DR. CESAR EVARISTO CABALLERO M.D.

Table of content: DR. CESAR EVARISTO CABALLERO M.D. (NPI 1316929540)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316929540 NPI number — DR. CESAR EVARISTO CABALLERO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CABALLERO
Provider First Name:
CESAR
Provider Middle Name:
EVARISTO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316929540
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1153 FALLING CREEK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEDFORD
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24523-3114
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-966-0872
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1613 OAKWOOD ST
Provider Second Line Business Practice Location Address:
BEDFORD MEMORIAL HOSPITAL EMERGENCY DEPARTMENT
Provider Business Practice Location Address City Name:
BEDFORD
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24523-1213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-586-9500
Provider Business Practice Location Address Fax Number:
540-586-7364
Provider Enumeration Date:
11/15/2005

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: 207Q00000X , with the licence number:  0101045523 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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