Provider Demographics
NPI:1689809386
Name:CAPITOL DERMATOPATHOLOGY, L.L.C.
Entity Type:Organization
Organization Name:CAPITOL DERMATOPATHOLOGY, L.L.C.
Other - Org Name:CAPITOL DERMATOPATHOLOGY LABORATORY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER AND MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHYI-CHIA
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:240-328-6818
Mailing Address - Street 1:119 AUTUMN WIND WAY
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-2872
Mailing Address - Country:US
Mailing Address - Phone:240-750-0285
Mailing Address - Fax:
Practice Address - Street 1:119 AUTUMN WIND WAY
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-2872
Practice Address - Country:US
Practice Address - Phone:240-750-0285
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-25
Last Update Date:2009-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21D1099518291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory