Provider Demographics
NPI:1689936304
Name:CAPITAL PRIMARY AND GERIATRIC CARE, LLC
Entity Type:Organization
Organization Name:CAPITAL PRIMARY AND GERIATRIC CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALOYSIUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-258-1904
Mailing Address - Street 1:100 1ST ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20851-1314
Mailing Address - Country:US
Mailing Address - Phone:301-258-1904
Mailing Address - Fax:301-339-7722
Practice Address - Street 1:100 1ST ST
Practice Address - Street 2:SUITE 130
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20851-1314
Practice Address - Country:US
Practice Address - Phone:301-258-1904
Practice Address - Fax:301-339-7722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-08
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD432933207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD024810000Medicaid
MD024810000Medicaid