Provider Demographics
NPI:1558351163
Name:CAPITAL PULMONARY INTERNISTS PC
Entity type:Organization
Organization Name:CAPITAL PULMONARY INTERNISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:D
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-296-4686
Mailing Address - Street 1:2440 M ST NW
Mailing Address - Street 2:#810
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-1475
Mailing Address - Country:US
Mailing Address - Phone:202-833-3000
Mailing Address - Fax:202-835-9040
Practice Address - Street 1:2440 M ST NW
Practice Address - Street 2:#810
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-1475
Practice Address - Country:US
Practice Address - Phone:202-833-3000
Practice Address - Fax:202-835-9040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-25
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD13891207R00000X
DCMD13325207RP1001X
DCMD12803207RP1001X
DCMD14045207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC026707600Medicaid
DC290009292OtherRAILROAD MEDICARE
DC759653Medicare ID - Type Unspecified
C62000Medicare UPIN
C62034Medicare UPIN
B92825Medicare UPIN
C61768Medicare UPIN