Provider Demographics
NPI:1740259886
Name:CAPUTO, THERESA M (MD)
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:M
Last Name:CAPUTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 HARTFORD RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-5921
Mailing Address - Country:US
Mailing Address - Phone:860-533-4673
Mailing Address - Fax:860-812-0305
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03756-0001
Practice Address - Country:US
Practice Address - Phone:603-650-5922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH22420207R00000X
CT022902207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001229020Medicaid
CT110110534OtherRAILROAD MEDICARE
CT515938OtherAETNA
CT01022902OtherCIGNA
CT0404268OtherUNITED
CT001229020Medicaid
CTC003687OtherCHAMPUS
CTHAP269OtherOXFORD
CT010022902CT01OtherBC/BS
CT050290OtherCONNECTICARE
CTHAP269OtherOXFORD
CT0404268OtherUNITED