=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255467106
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KEVIN PATRICK CAPUTO MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2007
-----------------------------------------------------
Last Update Date | 04/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 E LEHIGH AVE
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19125-1012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-707-8496
-----------------------------------------------------
Fax | 215-707-4086
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3500 N BROAD ST RM 1A
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19140-4106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-707-2433
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | MD036492E
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------