Provider Demographics
NPI:1154404135
Name:CAPONE, AMY E (PA-C)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:E
Last Name:CAPONE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:E
Other - Last Name:ALTLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-337-4168
Mailing Address - Fax:717-337-4249
Practice Address - Street 1:12 ST PAUL DR STE 104
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-1035
Practice Address - Country:US
Practice Address - Phone:717-263-8463
Practice Address - Fax:717-263-1103
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052717363A00000X, 363AM0700X
MDC003800363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101398627Medicaid