Provider Demographics
NPI:1831297282
Name:CAPITOL RADIOLOGY, LLC
Entity Type:Organization
Organization Name:CAPITOL RADIOLOGY, LLC
Other - Org Name:LAUREL RADIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEAD PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DORIANN
Authorized Official - Middle Name:R
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-725-5398
Mailing Address - Street 1:PO BOX 9200
Mailing Address - Street 2:DEPT 6
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-9200
Mailing Address - Country:US
Mailing Address - Phone:301-725-5398
Mailing Address - Fax:301-725-8968
Practice Address - Street 1:7350 VAN DUSEN RD
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5263
Practice Address - Country:US
Practice Address - Phone:301-725-5398
Practice Address - Fax:301-725-8968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD407762800Medicaid
DCG02054Medicare PIN