Provider Demographics
NPI:1083686497
Name:CABANISS, NEAL (PA)
Entity type:Individual
Prefix:
First Name:NEAL
Middle Name:
Last Name:CABANISS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2137 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-6806
Mailing Address - Country:US
Mailing Address - Phone:434-385-4184
Mailing Address - Fax:434-385-8616
Practice Address - Street 1:2137 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-6806
Practice Address - Country:US
Practice Address - Phone:434-385-4184
Practice Address - Fax:434-385-8616
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110-001982363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010114098Medicaid
VA006461C80Medicare PIN
VAQ34219Medicare UPIN
VA010114098Medicaid
006461C80Medicare PIN