Healthcare Provider Details

I. General information

NPI: 1104039650
Provider Name (Legal Business Name): CAPITAL HEART ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 03/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5215 LOUGHBORO RD NW SUITE 460
WASHINGTON DC
20016-2618
US

IV. Provider business mailing address

5215 LOUGHBORO RD NW SUITE 460
WASHINGTON DC
20016-2618
US

V. Phone/Fax

Practice location:
  • Phone: 202-686-9801
  • Fax: 202-363-6464
Mailing address:
  • Phone: 202-686-9801
  • Fax: 202-363-6464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD18999
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD25545
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA030947
License Number StateDC
# 4
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberMD18999
License Number StateDC

VIII. Authorized Official

Name: NANCY J. DAVENPORT
Title or Position: PRESIDENT
Credential: MD, PHD, FACC
Phone: 202-686-9801