Provider Demographics
NPI:1508906199
Name:CAPITAL INTERNAL MEDICINE & GERIATRICS, P.A.
Entity Type:Organization
Organization Name:CAPITAL INTERNAL MEDICINE & GERIATRICS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SYED
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-789-0892
Mailing Address - Street 1:3225 BLUE RIDGE RD STE 113
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-8060
Mailing Address - Country:US
Mailing Address - Phone:919-789-0891
Mailing Address - Fax:919-789-0893
Practice Address - Street 1:3225 BLUE RIDGE RD STE 113
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-8060
Practice Address - Country:US
Practice Address - Phone:919-789-0891
Practice Address - Fax:919-789-0893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2013-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9701680207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3404392Medicaid
NC2255752Medicare ID - Type Unspecified
NC3404392Medicaid