Provider Demographics
NPI:1578590923
Name:CABATAN, EDGARDO O (MD)
Entity Type:Individual
Prefix:
First Name:EDGARDO
Middle Name:O
Last Name:CABATAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1283 BEARPAW DR
Mailing Address - Street 2:
Mailing Address - City:DEFIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:43512-8559
Mailing Address - Country:US
Mailing Address - Phone:419-782-1196
Mailing Address - Fax:419-885-0203
Practice Address - Street 1:1283 BEARPAW DR
Practice Address - Street 2:
Practice Address - City:DEFIANCE
Practice Address - State:OH
Practice Address - Zip Code:43512-8559
Practice Address - Country:US
Practice Address - Phone:419-782-1196
Practice Address - Fax:419-885-0203
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35079199C2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2249810Medicaid
H36906Medicare UPIN
OH2249810Medicaid