1962453720 NPI number — CAPITAL INTERNAL MEDICINE,LLC

Table of content: (NPI 1962453720)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962453720 NPI number — CAPITAL INTERNAL MEDICINE,LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAPITAL INTERNAL MEDICINE,LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962453720
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/07/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 83819
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GAITHERSBURG
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20883-3819
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 FOREST GLEN RD
Provider Second Line Business Practice Location Address:
ATTN: HOSPITALISTS OFFICE
Provider Business Practice Location Address City Name:
SILVER SPRING
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20910-1483
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-754-7991
Provider Business Practice Location Address Fax Number:
301-754-7990
Provider Enumeration Date:
05/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHOPRA
Authorized Official First Name:
NEERAJ
Authorized Official Middle Name:
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
301-928-2422

Provider Taxonomy Codes

  • Taxonomy code: 208M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 403290000 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: KFR4CA . This is a "BCBS MD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: J095 . This is a "BCBS DC" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




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