Provider Demographics
NPI:1053404731
Name:CAPITOL CARE MEDICAL ASSOCIATES
Entity type:Organization
Organization Name:CAPITOL CARE MEDICAL ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-563-2844
Mailing Address - Street 1:1328 SOUTHERN AVE SE
Mailing Address - Street 2:312
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020
Mailing Address - Country:US
Mailing Address - Phone:202-563-2844
Mailing Address - Fax:202-563-2337
Practice Address - Street 1:1328 SOUTHERN AVE SE
Practice Address - Street 2:312
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020
Practice Address - Country:US
Practice Address - Phone:202-563-2844
Practice Address - Fax:202-563-2337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0063580174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCG02036Medicare ID - Type UnspecifiedMDCR GROUP #