Healthcare Provider Details

I. General information

NPI: 1821011990
Provider Name (Legal Business Name): ROBERT CAPODANNO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 STEVENS ST
NORWALK CT
06850-3852
US

IV. Provider business mailing address

24 STEVENS ST
NORWALK CT
06850-3852
US

V. Phone/Fax

Practice location:
  • Phone: 203-852-2016
  • Fax:
Mailing address:
  • Phone: 203-852-2016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number000528
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: