Provider Demographics
NPI:1457665580
Name:CAPACI, CHARLES J (PA-C)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:J
Last Name:CAPACI
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:455 PENNSYLVANIA AVE STE 127
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-3409
Mailing Address - Country:US
Mailing Address - Phone:215-793-9755
Mailing Address - Fax:215-793-4974
Practice Address - Street 1:1240 S BROAD ST STE 200
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-5395
Practice Address - Country:US
Practice Address - Phone:215-361-3376
Practice Address - Fax:215-412-3587
Is Sole Proprietor?:No
Enumeration Date:2010-07-30
Last Update Date:2020-08-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMA054469363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA054469OtherPA STATE LICENCE