Provider Demographics
NPI:1316963747
Name:CAPITAL ORTHOPAEDIC SPECIALISTS, P.A.
Entity type:Organization
Organization Name:CAPITAL ORTHOPAEDIC SPECIALISTS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:DUSHUTTLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-678-4513
Mailing Address - Street 1:240 BEISER BLVD
Mailing Address - Street 2:STE 101
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-7790
Mailing Address - Country:US
Mailing Address - Phone:302-678-4513
Mailing Address - Fax:302-678-3193
Practice Address - Street 1:240 BEISER BLVD
Practice Address - Street 2:STE 101
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-7790
Practice Address - Country:US
Practice Address - Phone:302-678-4513
Practice Address - Fax:302-678-3193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10002447174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000134402Medicaid
DE0000134402Medicaid