Basic Information
| Provider Information | |||||||||
| NPI: | 1649254012 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAPPELLARI | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | OLIVER | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | IV | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 344 | ||||||||
| Address2: | |||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271020344 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367162255 | ||||||||
| FaxNumber: | 3367167595 | ||||||||
| Practice Location | |||||||||
| Address1: | MEDICAL CENTER BLVD | ||||||||
| Address2: | |||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271570001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367162255 | ||||||||
| FaxNumber: | 3367167595 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2005 | ||||||||
| LastUpdateDate: | 08/19/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0101X | 38309 | NC | N | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology | 207ZC0500X | 38309 | NC | Y | Allopathic & Osteopathic Physicians | Pathology | Cytopathology |
ID Information
| ID | Type | State | Issuer | Description | 10292 | 01 | NC | PARTNERS | OTHER | 211607000 | 05 | WV | MEDICAID | 64233 | 01 | NC | MEDCOST | OTHER | 6602681 | 05 | VA | MEDICAID | 21079 | 01 | NC | BLUE CROSS | OTHER | 7801770 | 01 | NC | AETNA | OTHER | 8921079 | 05 | NC | MEDICAID | Q38309 | 05 | SC | MEDICAID |