Provider Demographics
NPI:1114217643
Name:CAPONE, AVERY C (MD)
Entity Type:Individual
Prefix:
First Name:AVERY
Middle Name:C
Last Name:CAPONE
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 1:5727 CENTRE AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-3707
Mailing Address - Country:US
Mailing Address - Phone:412-363-6626
Mailing Address - Fax:412-363-7008
Practice Address - Street 1:5727 CENTRE AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-3707
Practice Address - Country:US
Practice Address - Phone:412-363-6626
Practice Address - Fax:412-363-7008
Is Sole Proprietor?:No
Enumeration Date:2011-04-18
Last Update Date:2019-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD467567208600000X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery