Healthcare Provider Details

I. General information

NPI: 1255150025
Provider Name (Legal Business Name): CAPITAL AREA PHYSICIAN WEIGHT & WELLNESS CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2024
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44121 LEESBURG PIKE STE 250
ASHBURN VA
20147-5674
US

IV. Provider business mailing address

44121 LEESBURG PIKE STE 250
ASHBURN VA
20147-5674
US

V. Phone/Fax

Practice location:
  • Phone: 703-494-1020
  • 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 Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: SREE LAKSHMI GOGINENI
Title or Position: PRESIDENT
Credential:
Phone: 703-255-6010