Provider Demographics
NPI:1164169926
Name:CAPITAL COLON & RECTAL CLINIC, PA
Entity Type:Organization
Organization Name:CAPITAL COLON & RECTAL CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COLON & RECTAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:PREETHA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-325-3377
Mailing Address - Street 1:22626 TATE ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20871-6393
Mailing Address - Country:US
Mailing Address - Phone:301-325-3377
Mailing Address - Fax:
Practice Address - Street 1:602 S ATWOOD RD STE 205
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4329
Practice Address - Country:US
Practice Address - Phone:410-803-2211
Practice Address - Fax:410-420-9841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-13
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
12716723OtherCAQH