Provider Demographics
NPI:1720020993
Name:ELLEN MARY CABE
Entity Type:Organization
Organization Name:ELLEN MARY CABE
Other - Org Name:CHAPMANVILLE PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:CABE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-855-5083
Mailing Address - Street 1:22 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:CHAPMANVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25508-9698
Mailing Address - Country:US
Mailing Address - Phone:304-855-5083
Mailing Address - Fax:304-855-5729
Practice Address - Street 1:22 AIRPORT ROAD
Practice Address - Street 2:
Practice Address - City:CHAPMANVILLE
Practice Address - State:WV
Practice Address - Zip Code:25508
Practice Address - Country:US
Practice Address - Phone:304-855-5083
Practice Address - Fax:304-855-5729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001789668OtherBCBS
423068OtherCARELINK
WV1808261000Medicaid
2167633OtherMAMSI
0007016476OtherAETNA
61802OtherCARELINK MEDICAID
62076OtherUNICARE
61802OtherCARELINK MEDICAID
WVH62494Medicare UPIN