Provider Demographics
NPI:1073534319
Name:CAPSTACK, TIMOTHY M (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:M
Last Name:CAPSTACK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7250 PARKWAY DR STE 500
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-1343
Mailing Address - Country:US
Mailing Address - Phone:443-949-0814
Mailing Address - Fax:443-949-0825
Practice Address - Street 1:2001 MEDICAL PKWY
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3280
Practice Address - Country:US
Practice Address - Phone:443-481-1000
Practice Address - Fax:443-949-0825
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2022-05-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD66753208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD015649300Medicaid
344PS052Medicare Oscar/Certification
MD015649300Medicaid