Provider Demographics
NPI:1649254012
Name:CAPPELLARI, JAMES OLIVER IV (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:OLIVER
Last Name:CAPPELLARI
Suffix:IV
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 344
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27102-0344
Mailing Address - Country:US
Mailing Address - Phone:336-716-2255
Mailing Address - Fax:336-716-7595
Practice Address - Street 1:MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0001
Practice Address - Country:US
Practice Address - Phone:336-716-2255
Practice Address - Fax:336-716-7595
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC38309207ZP0101X, 207ZC0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC10292OtherPARTNERS
WV211607000Medicaid
NC64233OtherMEDCOST
VA6602681Medicaid
NC21079OtherBLUE CROSS
NC7801770OtherAETNA
NC8921079Medicaid
SCQ38309Medicaid
WV211607000Medicaid
VA6602681Medicaid