Provider Demographics
NPI:1376795963
Name:GUY CAPPUCCINO, MD LLC
Entity Type:Organization
Organization Name:GUY CAPPUCCINO, MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GUY
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPPUCCINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-829-4110
Mailing Address - Street 1:1304 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:MD
Mailing Address - Zip Code:21771-5329
Mailing Address - Country:US
Mailing Address - Phone:301-829-4110
Mailing Address - Fax:301-769-5768
Practice Address - Street 1:1304 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:MD
Practice Address - Zip Code:21771-5329
Practice Address - Country:US
Practice Address - Phone:301-829-4110
Practice Address - Fax:301-769-5768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-15
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00669082086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD134568Medicare PIN