Healthcare Provider Details

I. General information

NPI: 1073782983
Provider Name (Legal Business Name): C A CAHALL MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2008
Last Update Date: 04/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 FOX LN
CHESTER WV
26034-1599
US

IV. Provider business mailing address

205 W SIXTH ST
EAST LIVERPOOL OH
43920-2801
US

V. Phone/Fax

Practice location:
  • Phone: 304-387-3344
  • Fax: 304-387-3006
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
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN215713
License Number StateOH

VIII. Authorized Official

Name: DR. CLEMENT A CAHALL
Title or Position: PRESIDENT
Credential: MD
Phone: 330-385-9509