Provider Demographics
NPI:1184366858
Name:CABANISS, COURTNEY LEIGH (DO)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:LEIGH
Last Name:CABANISS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CAOURTNEY
Other - Middle Name:LEIGH
Other - Last Name:BRANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:43 WHITING HILL RD STE 300
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1006
Mailing Address - Country:US
Mailing Address - Phone:207-973-5000
Mailing Address - Fax:207-973-5042
Practice Address - Street 1:1309 MAIN ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:ME
Practice Address - Zip Code:04927-3134
Practice Address - Country:US
Practice Address - Phone:207-426-0976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-12
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MEDO4147207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program