Provider Demographics
NPI:1871632232
Name:CAPOZZOLI, NICHOLAS A (MD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:A
Last Name:CAPOZZOLI
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 1:122 DEFENSE HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7069
Mailing Address - Country:US
Mailing Address - Phone:410-263-9490
Mailing Address - Fax:410-263-9593
Practice Address - Street 1:122 DEFENSE HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7069
Practice Address - Country:US
Practice Address - Phone:410-263-9490
Practice Address - Fax:410-263-9593
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDOO1668O2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCE2380001OtherCAREFIRST BLUE SHIELD
MDLL23NIOtherCAREFIRST BLUE SHIELD
MD771L773DMedicare ID - Type UnspecifiedMEDICARE NUMBER
DCE2380001OtherCAREFIRST BLUE SHIELD