Provider Demographics
NPI:1407886781
Name:CAPITAL PAIN MANAGEMENT & ANESTHESIA ASSOCIATES, LLC
Entity Type:Organization
Organization Name:CAPITAL PAIN MANAGEMENT & ANESTHESIA ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR(FINANCE)
Authorized Official - Prefix:MR
Authorized Official - First Name:GIRIDHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:GOGINENI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-668-4403
Mailing Address - Street 1:141 THOMAS JOHNSON DR STE 190
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4509
Mailing Address - Country:US
Mailing Address - Phone:301-668-4403
Mailing Address - Fax:301-668-4406
Practice Address - Street 1:701 CHARLES ST
Practice Address - Street 2:CIVISTA MEDICAL CENTER
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-5930
Practice Address - Country:US
Practice Address - Phone:800-422-8585
Practice Address - Fax:301-934-6958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD702LMedicare ID - Type Unspecified