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General NPI Number Information
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NPI Number | 1952628851
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Entity Type | Organization
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Legal Business Name | CAPITAL HEALTH & WELLNESS
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Dates
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Enumeration Date | 05/01/2010
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Last Update Date | 05/01/2010
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Provider Practice Location Address
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Address Line | 17904 GEORGIA AVE STE 304
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City | OLNEY
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State | MD
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Zip | 20832-2278
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Country | US
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Telephone | 301-924-2790
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Fax |
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Provider Business Mailing Address
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Address Line | 4875 W EDDY DR APT 219
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City | LEWISTON
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State | NY
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Zip | 14092-1177
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Country | US
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Telephone | 716-201-9026
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | KAVEH SADEGHI
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Credential | MD
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Telephone | 716-201-9026
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | D0070134
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License Number State | MD
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