Healthcare Provider Details

I. General information

NPI: 1912883174
Provider Name (Legal Business Name): CAPITOL CARDIOLOGY ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2025
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12150 ANNAPOLIS RD STE 105
GLENN DALE MD
20769-9183
US

IV. Provider business mailing address

8116 GOOD LUCK RD STE 305
LANHAM MD
20706-3508
US

V. Phone/Fax

Practice location:
  • Phone: 301-805-1250
  • Fax:
Mailing address:
  • Phone: 301-552-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: RAJENDRA R SHETTY
Title or Position: AUTHORIZED OFFICAL
Credential:
Phone: 301-552-1200