1760661078 NPI number — CLAIRE MEGAN CAPOBIANCO

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760661078 NPI number — CLAIRE MEGAN CAPOBIANCO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAPOBIANCO
Provider First Name:
CLAIRE
Provider Middle Name:
MEGAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COATES
Provider Other First Name:
CLAIRE
Provider Other Middle Name:
MEGAN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPM
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1760661078
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/23/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
211 EXECUTIVE DR STE 11
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19702-3358
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-451-6913
Provider Business Mailing Address Fax Number:
302-368-7756

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12100 BLACK SWAN DRIVE
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
LEWES
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19958-4988
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-644-3311
Provider Business Practice Location Address Fax Number:
302-644-3300
Provider Enumeration Date:
11/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  PL00000803 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0103X , with the licence number: 1900 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0103X , with the licence number: E10000199 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1760661078 . This is a "GREAT WEST HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1760661078 . This is a "UNION LABOR LIFE INSURANCE COMPANY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1760661078 . This is a "DEVON HEALTH SERVICES" identifier . This identifiers is of the category "OTHER".
  • Identifier: 203612102 . This is a "CSHCN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 349330 . This is a "UNISON HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1760661078 . This is a "MULTIPLAN, INC." identifier . This identifiers is of the category "OTHER".
  • Identifier: 1760661078 . This is a "CORVEL / CORCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1760661078 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1184681488 . This is a "COMMERCIAL INSURANCES" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1760661078 . This is a "PRIVATE HEALTHCARE SYSTEMS/UNICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1760661078 . This is a "COVENTRY HEALTH CARE OF DELAWARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1760661078 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1760661078 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1760661078 . This is a "HEALTH NET FEDERAL SERVICES - TRICARE/CHAMPUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1760661078 . This is a "EASTERN SUSSEX PHYSICIANS ORGANIZATION (ESPO)" identifier . This identifiers is of the category "OTHER".
  • Identifier: 203612101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1760661078 . This is a "ONE NET PPO, MAMSI, OPTIMUM CHOICE, M.D. IPA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1760661078 . This is a "PERDUE FARMS, INC." identifier . This identifiers is of the category "OTHER".
  • Identifier: 1760661078 . This is a "COMMUNITY HEALTH PLAN" identifier . This identifiers is of the category "OTHER".




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