Provider Demographics
NPI:1043073588
Name:CAPITOL KETAMINE AND WELLNESS
Entity Type:Organization
Organization Name:CAPITOL KETAMINE AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BELETSHACHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:GIRMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:267-259-1182
Mailing Address - Street 1:3301 NEW MEXICO AVE NW STE 228
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-3610
Mailing Address - Country:US
Mailing Address - Phone:202-481-0947
Mailing Address - Fax:
Practice Address - Street 1:3301 NEW MEXICO AVE NW STE 228
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-3610
Practice Address - Country:US
Practice Address - Phone:202-481-0947
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty