Healthcare Provider Details

I. General information

NPI: 1184650608
Provider Name (Legal Business Name): CAPITAL PHYSICIANS GROUP, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 02/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3126 BLUE RIDGE RD
RALEIGH NC
27612-8006
US

IV. Provider business mailing address

3126 BLUE RIDGE RD
RALEIGH NC
27612-8006
US

V. Phone/Fax

Practice location:
  • Phone: 919-787-0486
  • Fax: 919-787-9931
Mailing address:
  • Phone: 919-787-0486
  • Fax: 919-787-9931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: MOHAMMAD H BALOCH
Title or Position: PHYSICIAN/ OWNER
Credential: MD
Phone: 919-787-0486