Provider Demographics
NPI:1659864775
Name:CAPITOL VASCULAR AND ONCOLOGY INSTITUTE, LLC
Entity Type:Organization
Organization Name:CAPITOL VASCULAR AND ONCOLOGY INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HYUN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-358-6070
Mailing Address - Street 1:PO BOX 902
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-0902
Mailing Address - Country:US
Mailing Address - Phone:301-358-6070
Mailing Address - Fax:301-358-6111
Practice Address - Street 1:7704 MATAPEAKE BUSINESS DR STE 130
Practice Address - Street 2:
Practice Address - City:BRANDYWINE
Practice Address - State:MD
Practice Address - Zip Code:20613-3049
Practice Address - Country:US
Practice Address - Phone:301-358-6070
Practice Address - Fax:301-358-6111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-13
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD7776403000Medicaid
DC013917967Medicaid