Healthcare Provider Details

I. General information

NPI: 1275504326
Provider Name (Legal Business Name): EDWARD W CAPPARELLI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 11/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 INDUSTRIAL LN
ONEIDA TN
37841-6294
US

IV. Provider business mailing address

470 INDUSTRIAL LN
ONEIDA TN
37841-6294
US

V. Phone/Fax

Practice location:
  • Phone: 423-569-3800
  • Fax: 423-569-1744
Mailing address:
  • Phone: 423-286-4141
  • Fax: 423-286-4145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD24202
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: