Provider Demographics
NPI:1184650608
Name:CAPITAL PHYSICIANS GROUP, PA
Entity Type:Organization
Organization Name:CAPITAL PHYSICIANS GROUP, PA
Other - Org Name:CAPITAL PHYSICIANS GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:H
Authorized Official - Last Name:BALOCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-787-0486
Mailing Address - Street 1:3126 BLUE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-8006
Mailing Address - Country:US
Mailing Address - Phone:919-787-0486
Mailing Address - Fax:919-787-9931
Practice Address - Street 1:3126 BLUE RIDGE RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-8006
Practice Address - Country:US
Practice Address - Phone:919-787-0486
Practice Address - Fax:919-787-9931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No305R00000XManaged Care OrganizationsPreferred Provider Organization
No305S00000XManaged Care OrganizationsPoint of ServiceGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890158KMedicaid
NC890158KMedicaid