Healthcare Provider Details

I. General information

NPI: 1609697770
Provider Name (Legal Business Name): CAPITAL WOMEN'S CARE, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2024
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6565 N CHARLES ST STE 212
BALTIMORE MD
21204-5805
US

IV. Provider business mailing address

5801 POSTAL RD
CLEVELAND OH
44181-2184
US

V. Phone/Fax

Practice location:
  • Phone: 410-823-1120
  • Fax: 410-296-9009
Mailing address:
  • Phone: 301-340-8339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DAMON HOU
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 301-340-8339