Provider Demographics
NPI:1902971807
Name:C A CAHALL MD, INC
Entity Type:Organization
Organization Name:C A CAHALL MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLEMENT
Authorized Official - Middle Name:A
Authorized Official - Last Name:CAHALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-385-9509
Mailing Address - Street 1:205 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:EAST LIVERPOOL
Mailing Address - State:OH
Mailing Address - Zip Code:43920-2801
Mailing Address - Country:US
Mailing Address - Phone:330-385-9509
Mailing Address - Fax:330-385-1008
Practice Address - Street 1:119 W 6TH ST
Practice Address - Street 2:
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-2921
Practice Address - Country:US
Practice Address - Phone:330-385-9509
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35081145207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810005352Medicaid
OH9326201Medicare ID - Type UnspecifiedMEDICARE GROUP ID NUMBER