Provider Demographics
NPI:1265647176
Name:CAPITAL IMAGING LLC
Entity Type:Organization
Organization Name:CAPITAL IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:KOMISKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-519-9200
Mailing Address - Street 1:4927 AUBURN AVE
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-2641
Mailing Address - Country:US
Mailing Address - Phone:301-718-3411
Mailing Address - Fax:301-718-0805
Practice Address - Street 1:4927 AUBURN AVE
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-2641
Practice Address - Country:US
Practice Address - Phone:301-718-3411
Practice Address - Fax:301-718-0805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM2252085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD408829800Medicaid
MDFDX022Medicare PIN