Provider Demographics
NPI:1629786181
Name:CAPITAL LUNG
Entity Type:Organization
Organization Name:CAPITAL LUNG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:POOYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-636-9919
Mailing Address - Street 1:9845 CORAL BELLS CT
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-1470
Mailing Address - Country:US
Mailing Address - Phone:703-636-9919
Mailing Address - Fax:
Practice Address - Street 1:8230 BOONE BLVD STE 203
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-2647
Practice Address - Country:US
Practice Address - Phone:703-636-9919
Practice Address - Fax:703-636-9452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101257751OtherVA STATE BUSINESS LICENSE