Healthcare Provider Details

I. General information

NPI: 1457533135
Provider Name (Legal Business Name): CAPITOL MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2007
Last Update Date: 12/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 SOUTHERN AVENUE
WASHINGTON DC
20032
US

IV. Provider business mailing address

105 BUSINESS CENTER 155 FLEET STREET
PORTSMOUTH NH
03801
US

V. Phone/Fax

Practice location:
  • Phone: 202-546-5700
  • Fax: 202-675-0411
Mailing address:
  • Phone: 202-546-5700
  • Fax: 202-675-0411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282J00000X
TaxonomyReligious Nonmedical Health Care Institution
License Number
License Number State

VIII. Authorized Official

Name: MR. ERIC F RIESEBERG
Title or Position: CHAIRMAN
Credential:
Phone: 202-546-5700