Provider Demographics
NPI:1174828529
Name:CAPITOL ANESTHESIA GROUP LLC
Entity Type:Organization
Organization Name:CAPITOL ANESTHESIA GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:HEGAB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-716-1097
Mailing Address - Street 1:PO BOX 221732
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20153-1732
Mailing Address - Country:US
Mailing Address - Phone:703-716-1097
Mailing Address - Fax:703-828-0942
Practice Address - Street 1:3028 JAVIER RD STE 400
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4622
Practice Address - Country:US
Practice Address - Phone:703-716-1097
Practice Address - Fax:703-828-0942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-17
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty