Provider Demographics
NPI:1225102502
Name:CAPITAL NEUROLOGY
Entity Type:Organization
Organization Name:CAPITAL NEUROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:P
Authorized Official - Last Name:DIFAZIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-309-2211
Mailing Address - Street 1:9715 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 414
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3320
Mailing Address - Country:US
Mailing Address - Phone:301-309-2211
Mailing Address - Fax:301-217-9303
Practice Address - Street 1:2730 PROSPERITY AVE STE B
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4330
Practice Address - Country:US
Practice Address - Phone:703-289-1450
Practice Address - Fax:703-289-1414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00629462084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty