Provider Demographics
NPI:1578501318
Name:CAPRON, IRENE R (PA)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:R
Last Name:CAPRON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 S SALINA ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-3527
Mailing Address - Country:US
Mailing Address - Phone:315-476-7921
Mailing Address - Fax:315-474-1448
Practice Address - Street 1:819 S SALINA ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-3527
Practice Address - Country:US
Practice Address - Phone:315-476-7921
Practice Address - Fax:315-474-1448
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010794363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02772136Medicaid
PA1413Medicare PIN
Q70155Medicare UPIN