Healthcare Provider Details

I. General information

NPI: 1902971807
Provider Name (Legal Business Name): C A CAHALL MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 W 6TH ST
EAST LIVERPOOL OH
43920-2921
US

IV. Provider business mailing address

205 W 6TH ST
EAST LIVERPOOL OH
43920-2801
US

V. Phone/Fax

Practice location:
  • Phone: 330-385-9509
  • Fax:
Mailing address:
  • Phone: 330-385-9509
  • Fax: 330-385-1008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35081145
License Number StateOH

VIII. Authorized Official

Name: CLEMENT A CAHALL
Title or Position: OWNER
Credential: M.D.
Phone: 330-385-9509