Provider Demographics
NPI:1255350153
Name:CAPONE, RICHARD R (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:R
Last Name:CAPONE
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:PO BOX 636930
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-0001
Mailing Address - Country:US
Mailing Address - Phone:513-981-5015
Mailing Address - Fax:
Practice Address - Street 1:967 BELLEFONTAINE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-2888
Practice Address - Country:US
Practice Address - Phone:419-996-5077
Practice Address - Fax:419-996-5483
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35040586207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0334196Medicaid
OH000000349631OtherANTHEM B.C.
OH0436176Medicare PIN
OHA76237Medicare UPIN