1013990167 NPI number — DR. VINCENT CAPOSTAGNO M.D.

Table of content: DR. VINCENT CAPOSTAGNO M.D. (NPI 1013990167)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013990167 NPI number — DR. VINCENT CAPOSTAGNO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAPOSTAGNO
Provider First Name:
VINCENT
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013990167
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2234 COLONIAL BLVD
Provider Second Line Business Mailing Address:
MANAGED CARE DEPARTMENT
Provider Business Mailing Address City Name:
FORT MYERS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33907-1412
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-931-7342
Provider Business Mailing Address Fax Number:
239-931-7385

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
41 S COLUMBUS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LITTLESTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17340-1439
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-359-5111
Provider Business Practice Location Address Fax Number:
717-359-4620
Provider Enumeration Date:
11/22/2005

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: 2085R0001X , with the licence number:  MD430192 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000214405 . This is a "UNISON HEALTH PLANS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1937133 . This is a "HIGHMARK BCBS PROV. #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 20057989 . This is a "AMERIHEALTH MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 905967-02 . This is a "CAREFIRST BCBS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P00652663 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 905967-01 . This is a "CAREFIRST BCBS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0001 . This is a "CAREFIRST BCBS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0672037 . This is a "CIGNA PROVIDER #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1018655070001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1461723 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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