Healthcare Provider Details

I. General information

NPI: 1720126121
Provider Name (Legal Business Name): CAPITAL PODIATRY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 04/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 19TH ST NW SUITE 409
WASHINGTON DC
20036-3701
US

IV. Provider business mailing address

1145 19TH ST NW SUITE 409
WASHINGTON DC
20036-3701
US

V. Phone/Fax

Practice location:
  • Phone: 202-223-0500
  • Fax: 202-296-2531
Mailing address:
  • Phone: 202-223-0500
  • Fax: 202-296-2531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO564
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO326
License Number StateDC

VIII. Authorized Official

Name: DR. ARNOLD S RAVICK
Title or Position: PODIARIST
Credential: D.P.M.
Phone: 202-223-0500