Healthcare Provider Details

I. General information

NPI: 1396365557
Provider Name (Legal Business Name): SAMANTHA CAPPUCCINO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2020
Last Update Date: 03/18/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8171 MAPLE LAWN BLVD STE 100
FULTON MD
20759-2527
US

IV. Provider business mailing address

5801 POST ROAD, UNIT 81310
CLEVELAND OH
44181-2112
US

V. Phone/Fax

Practice location:
  • Phone: 410-531-7557
  • Fax: 410-531-0818
Mailing address:
  • Phone: 301-340-8339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberD0099964
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: