Basic Information
| Provider Information | |||||||||
| NPI: | 1639155369 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAPPELLI | ||||||||
| FirstName: | LORRAINE | ||||||||
| MiddleName: | |||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1769 | ||||||||
| Address2: | |||||||||
| City: | MIDDLEBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201181769 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5406878181 | ||||||||
| FaxNumber: | 5406878256 | ||||||||
| Practice Location | |||||||||
| Address1: | 3031 JAVIER RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | FAIRFAX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220314637 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7032081002 | ||||||||
| FaxNumber: | 7032081127 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/15/2005 | ||||||||
| LastUpdateDate: | 11/02/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 2305001448 | VA | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | K342-0012 | 01 | VA | CAREFIRST | OTHER | 7975531 | 01 | VA | AETNA | OTHER | 4123410 | 01 | VA | MAMSI | OTHER | 175382 | 01 | VA | ANTHEM | OTHER | 3795591 | 01 | VA | AETNA-HMO | OTHER |