Healthcare Provider Details
I. General information
NPI: 1093766289
Provider Name (Legal Business Name): CAPITAL WOMEN'S CARE, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 05/13/2006
Last Update Date: 10/25/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:
III. Provider practice location address
61 THOMAS JOHNSON DR
FREDERICK MD
21702-4301
US
IV. Provider business mailing address
61 THOMAS JOHNSON DR
FREDERICK MD
21702-4301
US
V. Phone/Fax
- Phone: 301-663-6171
- Fax: 301-695-4469
- Phone: 301-663-6171
- Fax: 301-695-4469
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207V00000X |
| Taxonomy | Obstetrics & Gynecology Physician |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 261QA1903X |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| License Number | A1425 |
| License Number State | MD |
VIII. Authorized Official
Name: DR.
DAMON
HOU
Title or Position: MEDICAL DIRECTOR
Credential:
Phone: 301-340-8339