Healthcare Provider Details

I. General information

NPI: 1558351692
Provider Name (Legal Business Name): ALBERTO M CABANTOG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 11/03/2023
Certification Date: 11/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 W 11TH ST STE 103
ERIE PA
16501-1758
US

IV. Provider business mailing address

308 S HARBOR CITY BLVD SUITE A
MELBOURNE FL
32901-1500
US

V. Phone/Fax

Practice location:
  • Phone: 814-790-5111
  • Fax:
Mailing address:
  • Phone: 321-733-0064
  • Fax: 321-733-7970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberME 96402
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberMD458018
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME96042
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: