Healthcare Provider Details

I. General information

NPI: 1326870999
Provider Name (Legal Business Name): CAPITOL CARDIOLOGY ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2024
Last Update Date: 01/17/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9701 APOLLO DR STE 200
LARGO MD
20774-4794
US

IV. Provider business mailing address

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

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RAJENDRA R SHETTY
Title or Position: PRESIDENT
Credential: MD
Phone: 301-552-1200