Healthcare Provider Details

I. General information

NPI: 1407046642
Provider Name (Legal Business Name): CAPITAL HOSPICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6404 IVY LN STE 801
GREENBELT MD
20770-1407
US

IV. Provider business mailing address

12470 TELECOM DR, STE 301 ATTN: LEGAL SVS
TEMPLE TERRACE FL
33637-0904
US

V. Phone/Fax

Practice location:
  • Phone: 301-883-0866
  • Fax:
Mailing address:
  • Phone: 813-871-8111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CRYSTAL BUCCIARELLI
Title or Position: VP, LEGAL SERVICES
Credential:
Phone: 813-871-8075