Healthcare Provider Details

I. General information

NPI: 1174828529
Provider Name (Legal Business Name): CAPITOL ANESTHESIA GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2011
Last Update Date: 03/05/2021
Certification Date: 03/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3028 JAVIER RD STE 400
FAIRFAX VA
22031-4622
US

IV. Provider business mailing address

PO BOX 221732
CHANTILLY VA
20153-1732
US

V. Phone/Fax

Practice location:
  • Phone: 703-716-1097
  • Fax: 703-828-0942
Mailing address:
  • Phone: 703-716-1097
  • Fax: 703-828-0942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: AHMED HEGAB
Title or Position: MEMBER
Credential: MD
Phone: 703-716-1097