Provider Demographics
NPI:1407836299
Name:CAPONE, PATRICK M (MD)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:M
Last Name:CAPONE
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 1:220 CAMPUS BLVD STE 320
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2889
Mailing Address - Country:US
Mailing Address - Phone:540-536-5100
Mailing Address - Fax:540-536-0235
Practice Address - Street 1:125 MEDICAL CIR
Practice Address - Street 2:SUITE A
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-3300
Practice Address - Country:US
Practice Address - Phone:540-667-1828
Practice Address - Fax:540-722-3658
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010489012084N0400X
VAN100204082084D0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084D0003XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyDiagnostic Neuroimaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0090116000Medicaid
VA289217OtherANTHEM
WV001717360OtherMOUNTAIN STATE BCBS
VA130007966OtherRAILROAD MEDICARE
VA006124381Medicaid
VA130000451Medicare PIN
VA006124381Medicaid