Healthcare Provider Details

I. General information

NPI: 1942774872
Provider Name (Legal Business Name): COURTNEY CAPUTO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2019
Last Update Date: 02/24/2022
Certification Date: 02/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30265 COMMERCE DR UNIT 103
MILLSBORO DE
19966-3594
US

IV. Provider business mailing address

100 RAWLINS DR
SEAFORD DE
19973-5881
US

V. Phone/Fax

Practice location:
  • Phone: 302-990-3280
  • Fax:
Mailing address:
  • Phone: 302-990-3280
  • Fax: 302-990-3290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberC5-0001311
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: