Provider Demographics
NPI:1669437604
Name:CAPONE, GAETANO (MD)
Entity type:Individual
Prefix:
First Name:GAETANO
Middle Name:
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 1:3998 RED LION RD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-1445
Mailing Address - Country:US
Mailing Address - Phone:215-281-0800
Mailing Address - Fax:215-281-2725
Practice Address - Street 1:3998 RED LION RD
Practice Address - Street 2:SUITE 306
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1445
Practice Address - Country:US
Practice Address - Phone:215-281-0800
Practice Address - Fax:215-281-2725
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD023698E207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000947024Medicaid
194900Medicare ID - Type Unspecified
B34423Medicare UPIN