Provider Demographics
NPI:1043259559
Name:CAPPIELLO, JUSTIN L (MD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:L
Last Name:CAPPIELLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 N DUKE ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-4952
Mailing Address - Country:US
Mailing Address - Phone:717-394-6808
Mailing Address - Fax:717-299-4133
Practice Address - Street 1:324 N DUKE ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-4952
Practice Address - Country:US
Practice Address - Phone:717-394-6808
Practice Address - Fax:717-299-4133
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA031932L207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA563815OtherBLUE SHIELD
PA0726097Medicaid
PA01154801OtherCAPITAL BLUE CROSS
PA0726097Medicaid
PA01154801OtherCAPITAL BLUE CROSS