1962129791 NPI number — CAPITAL VASCULAR AND INTERVENTIONAL RADIOLOGY SPECIALISTS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962129791 NPI number — CAPITAL VASCULAR AND INTERVENTIONAL RADIOLOGY SPECIALISTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAPITAL VASCULAR AND INTERVENTIONAL RADIOLOGY SPECIALISTS
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:
1962129791
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/24/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1865 E QUEENS CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CROFTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21114-2626
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-539-6860
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4201 MITCHELLVILLE RD STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOWIE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20716-3161
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-979-9716
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/24/2022

Additional Information

Authorized Official

Authorized Official Last Name:
AMADU
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
A
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
301-979-6716

Provider Taxonomy Codes

  • Taxonomy code: 2085R0204X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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