Provider Demographics
NPI:1366626657
Name:CAPITAL NEURO CARE PA
Entity Type:Organization
Organization Name:CAPITAL NEURO CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:RATNAVALI
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-869-2358
Mailing Address - Street 1:10301 GEORGIA AVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-5020
Mailing Address - Country:US
Mailing Address - Phone:301-593-9800
Mailing Address - Fax:301-593-1061
Practice Address - Street 1:16003 COMPRINT CIR STE 209
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-1318
Practice Address - Country:US
Practice Address - Phone:301-869-2358
Practice Address - Fax:301-869-2360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-21
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC039326600Medicaid
MD413840600Medicaid
DCG02802Medicare PIN