Healthcare Provider Details

I. General information

NPI: 1760849632
Provider Name (Legal Business Name): JENNA LYNNE CAPUANO D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2016
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S BRYN MAWR AVE
BRYN MAWR PA
19010-3120
US

IV. Provider business mailing address

101 S BRYN MAWR AVE
BRYN MAWR PA
19010-3120
US

V. Phone/Fax

Practice location:
  • Phone: 484-337-4400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number15844
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: