Provider Demographics
NPI:1588800155
Name:CAPP, KEVIN CHARLES (DO)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:CHARLES
Last Name:CAPP
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:926 WEST 38TH STREET
Mailing Address - Street 2:DR. KEVIN CAPP
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508
Mailing Address - Country:US
Mailing Address - Phone:814-866-1960
Mailing Address - Fax:814-866-1935
Practice Address - Street 1:926 WEST 38TH STREET
Practice Address - Street 2:DR. KEVIN CAPP
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508
Practice Address - Country:US
Practice Address - Phone:814-866-1960
Practice Address - Fax:814-866-1935
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOT012782207Q00000X
PAOSO15055207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1024989030002Medicaid
PA0266678OtherCIGNA
PA2538602OtherHIGHMARK BCBS
PA2538602OtherHIGHMARK BCBS
PA1024989030002Medicaid