Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 35.084735 | OH |
Y | 2081P2900X | Pain Medicine | 35.084735 | OH |
NPI | 1407843162 |
---|---|
Provider Name | Dr. Edwin L Capulong |
First Address | Chesterland, OH 44026-2447 |
Second Address | Cleveland, OH 44106-1716 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2005 |
Last Update Date | 30/11/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2495894 | (05) | OH |
I13997 | (02) |