MEDICARE: DR. ROGER WILLIAM CAPPELLO

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	207R00000X	Internal Medicine Physician	0101028270	VA

General Provider Information

NPI Number	:	1902872070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROGER WILLIAM CAPPELLO

Provider Business Mailing Address
First Line	:	7041 LEE PARK RD
Second Line	:
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23111-3682
Country	:	US
Telephone Number	:	804-723-3305
Fax Number	:

Provider Business Practice Location Address
First Line	:	7041 LEE PARK RD
Second Line	:
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23111-3682
Country	:	US
Telephone Number	:	804-723-3305
Fax Number	:

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

Provider Enumeration Date	:	02/27/2006
Last Update Date	:	05/13/2010

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