Provider Demographics
NPI:1588198808
Name:CAPITOL GASTRO, PA
Entity type:Organization
Organization Name:CAPITOL GASTRO, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MASI
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-637-7761
Mailing Address - Street 1:12701 RR 620 N STE 101
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-1141
Mailing Address - Country:US
Mailing Address - Phone:512-593-6022
Mailing Address - Fax:512-599-9130
Practice Address - Street 1:12701 RR 620 N STE 101
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-1141
Practice Address - Country:US
Practice Address - Phone:512-593-6022
Practice Address - Fax:512-599-9130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-13
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty