Provider Demographics
NPI:1265426969
Name:ERWIN B. CLAHASSEY M.D., A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:ERWIN B. CLAHASSEY M.D., A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERWIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:CLAHASSEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-652-5023
Mailing Address - Street 1:PO BOX 222098
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28222-2098
Mailing Address - Country:US
Mailing Address - Phone:866-932-6216
Mailing Address - Fax:
Practice Address - Street 1:147 N BRENT ST
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-2809
Practice Address - Country:US
Practice Address - Phone:805-652-5023
Practice Address - Fax:805-643-8511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-08
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW17333Medicare PIN