Healthcare Provider Details

I. General information

NPI: 1013990167
Provider Name (Legal Business Name): VINCENT CAPOSTAGNO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 02/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 S COLUMBUS AVE
LITTLESTOWN PA
17340-1439
US

IV. Provider business mailing address

2234 COLONIAL BLVD MANAGED CARE DEPARTMENT
FORT MYERS FL
33907-1412
US

V. Phone/Fax

Practice location:
  • Phone: 717-359-5111
  • Fax: 717-359-4620
Mailing address:
  • Phone: 239-931-7342
  • Fax: 239-931-7385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMD430192
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier000000214405
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerUNISON HEALTH PLANS
# 2
Identifier1937133
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHIGHMARK BCBS PROV. #
# 3
Identifier20057989
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerAMERIHEALTH MERCY
# 4
Identifier905967-02
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerCAREFIRST BCBS
# 5
IdentifierP00652663
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerRAILROAD MEDICARE
# 6
Identifier905967-01
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerCAREFIRST BCBS
# 7
Identifier0001
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerCAREFIRST BCBS
# 8
Identifier0672037
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerCIGNA PROVIDER #
# 9
Identifier1018655070001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 10
Identifier1461723
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerAETNA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: