Provider Demographics
NPI:1558351692
Name:CABANTOG, ALBERTO M (MD)
Entity Type:Individual
Prefix:DR
First Name:ALBERTO
Middle Name:M
Last Name:CABANTOG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:308 S HARBOR CITY BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-1500
Mailing Address - Country:US
Mailing Address - Phone:321-733-0064
Mailing Address - Fax:321-733-7970
Practice Address - Street 1:240 W 11TH ST STE 103
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16501-1758
Practice Address - Country:US
Practice Address - Phone:814-790-5111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME 96402208VP0014X
PAMD458018208VP0014X
FLME96042207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA202705274OtherGREAT WEST
MAAA58878OtherHPHC
MA202705274004OtherTRICARE
MA2036525Medicaid
MA7245558OtherAETNA
MA202705274OtherUNITTED HEALTHCARE
MA97130902OtherNETWORK HEALTH
PAMD458018OtherSTATE LICENSE
MA611000600OtherDOL
MA97130902OtherNETWORK HEALTH