Healthcare Provider Details

I. General information

NPI: 1891882098
Provider Name (Legal Business Name): CAPITOL CARE MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2006
Last Update Date: 08/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1328 SOUTHERN AVE SE SUITE 312
WASHINGTON DC
20032-4689
US

IV. Provider business mailing address

2113 PARKSIDE DR
BOWIE MD
20721-4227
US

V. Phone/Fax

Practice location:
  • Phone: 202-563-2844
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: JULIAN CRAIG
Title or Position: OWNER
Credential: MD
Phone: 202-563-2844