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General NPI Number Information
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NPI Number | 1588198808
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Entity Type | Organization
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Legal Business Name | CAPITOL GASTRO, PA
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Dates
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Enumeration Date | 04/13/2017
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Last Update Date | 11/18/2019
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Provider Practice Location Address
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Address Line | 12701 RR 620 N STE 101
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City | AUSTIN
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State | TX
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Zip | 78750-1141
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Country | US
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Telephone | 512-593-6022
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Fax | 512-599-9130
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Provider Business Mailing Address
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Address Line | 12701 RR 620 N STE 101
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City | AUSTIN
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State | TX
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Zip | 78750-1141
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Country | US
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Telephone | 512-593-6022
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Fax | 512-599-9130
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Authorized Official
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Title or Position | OWNER
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Name | MASI KHAJA
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Credential | MD
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Telephone | 830-637-7761
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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