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General NPI Number Information
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NPI Number | 1952306268
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Entity Type | Individual
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Provider Name | PAUL RAY CAPITO MD
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Gender | Male
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Dates
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Enumeration Date | 06/15/2005
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Last Update Date | 09/12/2020
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Provider Practice Location Address
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Address Line | 3623 LATROBE DR STE 216
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City | CHARLOTTE
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State | NC
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Zip | 28211
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Country | US
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Telephone | 704-332-1291
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Fax | 704-332-5206
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Provider Business Mailing Address
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Address Line | PO BOX 221249
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City | CHARLOTTE
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State | NC
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Zip | 28222-1249
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Country | US
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Telephone | 704-332-1291
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Fax | 704-332-5206
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207U00000X
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Taxonomy Name | Nuclear Medicine Physician
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License Number | 2002-01344
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 200201344
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 2002-01344
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License Number State | NC
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