Provider Demographics
NPI:1477667699
Name:CAPPADONA, JOHN T (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:T
Last Name:CAPPADONA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:183 DEERCLIFF RD
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-2852
Mailing Address - Country:US
Mailing Address - Phone:860-676-0218
Mailing Address - Fax:
Practice Address - Street 1:720 HOPMEADOW ST
Practice Address - Street 2:
Practice Address - City:SIMSBURY
Practice Address - State:CT
Practice Address - Zip Code:06070-2224
Practice Address - Country:US
Practice Address - Phone:860-651-3519
Practice Address - Fax:860-651-4133
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT032042207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004209898Medicaid
CT004209898Medicaid
CTB00122Medicare UPIN