Provider Demographics
NPI:1649378225
Name:CAPPUCCI, ROGER V (MD)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:V
Last Name:CAPPUCCI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:550 MAMARONECK AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:HARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10528-1634
Mailing Address - Country:US
Mailing Address - Phone:914-723-8100
Mailing Address - Fax:914-219-1928
Practice Address - Street 1:259 HEATHCOTE RD
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-4523
Practice Address - Country:US
Practice Address - Phone:914-723-8100
Practice Address - Fax:914-219-1928
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2016-02-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY182515207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01544976Medicaid
NY110118597OtherMEDICARE RAILROAD
NYF99106Medicare UPIN
NY01544976Medicaid