Healthcare Provider Details

I. General information

NPI: 1699528943
Provider Name (Legal Business Name): CAPITAL AREA INTERNAL MEDICINE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3581 OLD WASHINGTON RD # C
WALDORF MD
20602-3270
US

IV. Provider business mailing address

44121 LEESBURG PIKE STE 250
ASHBURN VA
20147-5674
US

V. Phone/Fax

Practice location:
  • Phone: 703-255-6010
  • Fax: 703-255-6011
Mailing address:
  • Phone: 703-255-6010
  • Fax: 703-255-6011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: SREE LAKSHMI GOGINENI
Title or Position: OWNER/AUTHORIZED OFFICIAL
Credential: MD
Phone: 703-255-6010