Healthcare Provider Details

I. General information

NPI: 1811216583
Provider Name (Legal Business Name): CAPITAL BREAST CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2010
Last Update Date: 05/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 PENNSYLVANIA AVE SE SUITE 230
WASHINGTON DC
20003-4318
US

IV. Provider business mailing address

650 PENNSYLVANIA AVE SE SUITE 230
WASHINGTON DC
20003-4318
US

V. Phone/Fax

Practice location:
  • Phone: 202-784-2700
  • Fax: 202-784-2722
Mailing address:
  • Phone: 202-784-2700
  • Fax: 202-784-2722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number82001962001
License Number StateDC

VIII. Authorized Official

Name: MS. BETH BECK
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 202-784-2707