Basic Information
| Provider Information | |||||||||
| NPI: | 1942774872 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CAPUTO | ||||||||
| FirstName: | COURTNEY | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 RAWLINS DR | ||||||||
| Address2: | |||||||||
| City: | SEAFORD | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199735881 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3029903280 | ||||||||
| FaxNumber: | 3029903290 | ||||||||
| Practice Location | |||||||||
| Address1: | 30265 COMMERCE DR UNIT 103 | ||||||||
| Address2: | |||||||||
| City: | MILLSBORO | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199663594 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3029903280 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/14/2019 | ||||||||
| LastUpdateDate: | 02/24/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | C5-0001311 | DE | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.