1760661078 NPI number — CLAIRE MEGAN CAPOBIANCO

Table of content: CLAIRE MEGAN CAPOBIANCO (NPI 1760661078)

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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