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NPI Code Detail

MEDICARE: MARA LEE CAPPELLONI PA-C

MEDICARE: MARA LEE CAPPELLONI PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician AssistantMA054517PA

General Provider Information

NPI Number : 1245428754
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARA LEE CAPPELLONI PA-C
Provider Business Mailing Address
First Line : 3400 SPRUCE ST
Second Line : 3 SILVERSTEIN
City : PHILADELPHIA
State : PA
Zip : 19104-4238
Country : US
Telephone Number : 215-662-3487
Fax Number : 215-349-5534
Provider Business Practice Location Address
First Line : 3400 SPRUCE ST
Second Line : 3 SILVERSTEIN
City : PHILADELPHIA
State : PA
Zip : 19104-4238
Country : US
Telephone Number : 215-662-3487
Fax Number : 215-349-5534
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2007
Last Update Date : 03/16/2026

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Directions to “ MARA LEE CAPPELLONI PA-C” Practice Location

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