Provider Demographics
NPI:1043202187
Name:KANAYJORN, ESTHER GRACE PABLO (MD)
Entity Type:Individual
Prefix:MRS
First Name:ESTHER
Middle Name:GRACE PABLO
Last Name:KANAYJORN
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 1:104 ERIN COURT
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45133-0070
Mailing Address - Country:US
Mailing Address - Phone:937-393-5781
Mailing Address - Fax:937-393-5784
Practice Address - Street 1:1092 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:OH
Practice Address - Zip Code:45123-8319
Practice Address - Country:US
Practice Address - Phone:937-981-1121
Practice Address - Fax:937-981-5660
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35077853-K207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH363844OtherRHC MEDICARE FACILITY #
OH2122096001OtherCIGNA
OH2355053OtherRHC MEDICAID FACILITY #
OH7724279OtherAETNA
OH000000184923OtherANTHEM BC/BS
OH0401451OtherUNITED HEALTH CARE
OH2214839Medicaid
OH000000184923OtherANTHEM BC/BS
OH363844OtherRHC MEDICARE FACILITY #