MEDICARE: MIA CAPUZZI 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
1	363AM0700X	Medical Physician Assistant	MA063598	PA

General Provider Information

NPI Number	:	1710617816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIA CAPUZZI PA-C

Provider Business Mailing Address
First Line	:	314 S KIMBERLY AVE
Second Line	:
City	:	SOMERSET
State	:	PA
Zip	:	15501-2223
Country	:	US
Telephone Number	:	814-443-8266
Fax Number	:	814-443-8261

Provider Business Practice Location Address
First Line	:	314 S KIMBERLY AVE
Second Line	:
City	:	SOMERSET
State	:	PA
Zip	:	15501-2223
Country	:	US
Telephone Number	:	814-443-8266
Fax Number	:	814-443-8261

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2022
Last Update Date	:	06/13/2022

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Directions to “ MIA CAPUZZI PA-C” Practice Location

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