Healthcare Provider Details

I. General information

NPI: 1699868463
Provider Name (Legal Business Name): CAPITOL MEDICAL ASSOCIATES,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 01/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6674 WESTON CIR W
DUBLIN OH
43016-7901
US

IV. Provider business mailing address

PO BOX 634230
CINCINNATI OH
45263-0001
US

V. Phone/Fax

Practice location:
  • Phone: 614-595-1055
  • Fax: 614-873-2040
Mailing address:
  • Phone: 614-595-1055
  • Fax: 614-873-2040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number StateOH

VIII. Authorized Official

Name: DR. GAVIN PAUL BAUMGARDNER
Title or Position: PRESIDENT
Credential: D.O.
Phone: 614-595-1055