Provider Demographics
NPI:1306803192
Name:CAPASSO, PATRIZIO (MD)
Entity type:Individual
Prefix:
First Name:PATRIZIO
Middle Name:
Last Name:CAPASSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3621 BARROW WOOD LN
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-6107
Mailing Address - Country:US
Mailing Address - Phone:702-234-7430
Mailing Address - Fax:
Practice Address - Street 1:3621 BARROW WOOD LN
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-6107
Practice Address - Country:US
Practice Address - Phone:702-234-7430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL361045332085R0202X
KY425952085R0204X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036104533Medicaid
KY7100077850Medicaid
KY7100077850Medicaid
H34150Medicare UPIN
KY00258312Medicare PIN