Provider Demographics
NPI:1275726218
Name:CAPPLEMAN EDWARDS AND CASTELLO MD PA
Entity Type:Organization
Organization Name:CAPPLEMAN EDWARDS AND CASTELLO MD PA
Other - Org Name:CAPPLEMAN MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VIRNNETT
Authorized Official - Middle Name:
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-877-8080
Mailing Address - Street 1:436 N DILLARD ST
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-2817
Mailing Address - Country:US
Mailing Address - Phone:407-877-8080
Mailing Address - Fax:407-877-0907
Practice Address - Street 1:436 N DILLARD ST
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-2817
Practice Address - Country:US
Practice Address - Phone:407-877-8080
Practice Address - Fax:407-877-0907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL38454OtherBLUE CROSS BLUE SHIELD FL
FL38454Medicare PIN