Provider Demographics
NPI: | 1942308770 |
---|---|
Name: | R.A. CAPONE, JR., M.D., P.C. |
Entity Type: | Organization |
Organization Name: | R.A. CAPONE, JR., M.D., P.C. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | RAYMOND |
Authorized Official - Middle Name: | A |
Authorized Official - Last Name: | CAPONE |
Authorized Official - Suffix: | JR |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 412-363-6626 |
Mailing Address - Street 1: | 5727 CENTRE AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | PITTSBURGH |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 15206-3707 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 412-363-6626 |
Mailing Address - Fax: | 412-363-7008 |
Practice Address - Street 1: | 5727 CENTRE AVE |
Practice Address - Street 2: | |
Practice Address - City: | PITTSBURGH |
Practice Address - State: | PA |
Practice Address - Zip Code: | 15206-3707 |
Practice Address - Country: | US |
Practice Address - Phone: | 412-363-6626 |
Practice Address - Fax: | 412-363-7008 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-09-20 |
Last Update Date: | 2013-10-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PA | MD428761 | 174400000X |
PA | MD035911L | 207L00000X, 207LA0401X, 207LC0200X, 207LP2900X |
PA | MD025515E | 207ZC0500X, 207ZH0000X, 207ZP0102X |
PA | MD025510E | 208200000X, 2082S0099X, 2082S0105X, 2086S0105X, 2086S0122X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208200000X | Allopathic & Osteopathic Physicians | Plastic Surgery | Group - Multi-Specialty | |
No | 174400000X | Other Service Providers | Specialist | Group - Multi-Specialty | |
No | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | Group - Multi-Specialty | |
No | 207LA0401X | Allopathic & Osteopathic Physicians | Anesthesiology | Addiction Medicine | Group - Multi-Specialty |
No | 207LC0200X | Allopathic & Osteopathic Physicians | Anesthesiology | Critical Care Medicine | Group - Multi-Specialty |
No | 207LP2900X | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | Group - Multi-Specialty |
No | 207ZC0500X | Allopathic & Osteopathic Physicians | Pathology | Cytopathology | Group - Multi-Specialty |
No | 207ZH0000X | Allopathic & Osteopathic Physicians | Pathology | Hematology | Group - Multi-Specialty |
No | 207ZP0102X | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | Group - Multi-Specialty |
No | 2082S0099X | Allopathic & Osteopathic Physicians | Plastic Surgery | Plastic Surgery Within the Head and Neck | Group - Multi-Specialty |
No | 2082S0105X | Allopathic & Osteopathic Physicians | Plastic Surgery | Surgery of the Hand | Group - Multi-Specialty |
No | 2086S0105X | Allopathic & Osteopathic Physicians | Surgery | Surgery of the Hand | Group - Multi-Specialty |
No | 2086S0122X | Allopathic & Osteopathic Physicians | Surgery | Plastic and Reconstructive Surgery | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
PA | 080381 | Other | HIGHMARK GROUP NUMBER |