Provider Demographics
NPI:1497999577
Name:CAPITAL HEART AND VASCULAR CENTER, LLC
Entity Type:Organization
Organization Name:CAPITAL HEART AND VASCULAR CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:AHUJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-721-4007
Mailing Address - Street 1:3311 TOLEDO TERR
Mailing Address - Street 2:B102
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-4151
Mailing Address - Country:US
Mailing Address - Phone:301-559-3500
Mailing Address - Fax:
Practice Address - Street 1:3311 TOLEDO TERR
Practice Address - Street 2:B102
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-4151
Practice Address - Country:US
Practice Address - Phone:301-559-3500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-21
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G92169Medicare UPIN
129522ZDJKMedicare PIN