Provider Demographics
NPI:1104863398
Name:CABE, ELLEN MARY (MD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:MARY
Last Name:CABE
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 1:765 LIBERTY ST
Mailing Address - Street 2:SUITE 111
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-2566
Mailing Address - Country:US
Mailing Address - Phone:814-336-6384
Mailing Address - Fax:814-724-2771
Practice Address - Street 1:765 LIBERTY ST
Practice Address - Street 2:SUITE 111
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-2566
Practice Address - Country:US
Practice Address - Phone:814-336-6384
Practice Address - Fax:814-724-2771
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD448471208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1028786800001Medicaid
0007016476OtherAETNA
2167633OtherMAMSI
423068OtherCARELINK
61802OtherCARELINK MEDICAID
0007016476OtherAETNA
62076OtherUNICARE
WV1808261000Medicaid