Basic Information
| Provider Information | |||||||||
| NPI: | 1578590923 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CABATAN | ||||||||
| FirstName: | EDGARDO | ||||||||
| MiddleName: | O | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1283 BEARPAW DR | ||||||||
| Address2: | |||||||||
| City: | DEFIANCE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435128559 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4197821196 | ||||||||
| FaxNumber: | 4198850203 | ||||||||
| Practice Location | |||||||||
| Address1: | 1283 BEARPAW DR | ||||||||
| Address2: | |||||||||
| City: | DEFIANCE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435128559 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4197821196 | ||||||||
| FaxNumber: | 4198850203 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2006 | ||||||||
| LastUpdateDate: | 06/14/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 35079199C | OH | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 2249810 | 05 | OH | MEDICAID |