Provider Demographics
NPI:1396039103
Name:CAPONE, JESSE LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:LEE
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:PO BOX 7527
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-0727
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5193 W BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-1691
Practice Address - Country:US
Practice Address - Phone:614-544-1450
Practice Address - Fax:614-533-0136
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35123787207Q00000X
WAMD60392311207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPENDINGMedicaid
PAPENDINGMedicare PIN