Provider Demographics
NPI:1770572547
Name:CABAUATAN, LIVIA N (MD)
Entity type:Individual
Prefix:DR
First Name:LIVIA
Middle Name:N
Last Name:CABAUATAN
Suffix:
Gender:F
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:PO BOX 1062
Mailing Address - Street 2:
Mailing Address - City:CHAPMANVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25508-1062
Mailing Address - Country:US
Mailing Address - Phone:304-310-2517
Mailing Address - Fax:304-310-2520
Practice Address - Street 1:462 MAIN ST
Practice Address - Street 2:
Practice Address - City:CHAPMANVILLE
Practice Address - State:WV
Practice Address - Zip Code:25508-4574
Practice Address - Country:US
Practice Address - Phone:304-310-2517
Practice Address - Fax:304-310-2517
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV14498207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0057541000Medicaid
WVWV1837B662Medicare PIN
WV2026694Medicare PIN
WVWV1837CMedicare PIN
WV2026692Medicare PIN
WVWV1837AMedicare PIN
WV2026695Medicare PIN
WVCA2026691Medicare ID - Type Unspecified
WV0057541000Medicaid
WV2026693Medicare PIN
WVWV1837BMedicare PIN
WVWV1837B663Medicare PIN