Healthcare Provider Details

I. General information

NPI: 1649383290
Provider Name (Legal Business Name): CAPITAL CARDIOLOGY CONSULTANTS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 11/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 VARNUM ST NE STE 100
WASHINGTON DC
20017-2106
US

IV. Provider business mailing address

1160 VARNUM ST NE STE 100
WASHINGTON DC
20017-2106
US

V. Phone/Fax

Practice location:
  • Phone: 202-832-1800
  • Fax: 202-832-2071
Mailing address:
  • Phone: 202-832-1800
  • Fax: 202-832-2071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DEANA MICHELE JEFFERSON
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 202-832-1800