Provider Demographics
NPI:1013990167
Name:CAPOSTAGNO, VINCENT (MD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:
Last Name:CAPOSTAGNO
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 1:2234 COLONIAL BLVD
Mailing Address - Street 2:MANAGED CARE DEPARTMENT
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:41 S COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:LITTLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:17340-1439
Practice Address - Country:US
Practice Address - Phone:717-359-5111
Practice Address - Fax:717-359-4620
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4301922085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000000214405OtherUNISON HEALTH PLANS
PA1937133OtherHIGHMARK BCBS PROV. #
PA20057989OtherAMERIHEALTH MERCY
PA905967-02OtherCAREFIRST BCBS
PAP00652663OtherRAILROAD MEDICARE
PA905967-01OtherCAREFIRST BCBS
PA0001OtherCAREFIRST BCBS
PA0672037OtherCIGNA PROVIDER #
PA1018655070001Medicaid
PA1461723OtherAETNA
PA000000214405OtherUNISON HEALTH PLANS
PA0001OtherCAREFIRST BCBS