Provider Demographics
NPI:1952557811
Name:CAPITOL HILL MEDICAL CLINIC
Entity Type:Organization
Organization Name:CAPITOL HILL MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:ANNIBELLE
Authorized Official - Last Name:VAN-COOTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-546-2219
Mailing Address - Street 1:201 8TH ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-6153
Mailing Address - Country:US
Mailing Address - Phone:202-546-7696
Mailing Address - Fax:202-546-8061
Practice Address - Street 1:201 8TH ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-6153
Practice Address - Country:US
Practice Address - Phone:202-546-7696
Practice Address - Fax:202-546-8061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDII00000314133V00000X
DCMD31662207R00000X
DCMD11388208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC024540800Medicaid