Provider Demographics
NPI:1689406258
Name:CAPITOL CARDIOLOGY ASSOCIATES, LLC
Entity type:Organization
Organization Name:CAPITOL CARDIOLOGY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJENDRA
Authorized Official - Middle Name:R
Authorized Official - Last Name:SHETTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-552-1200
Mailing Address - Street 1:8116 GOOD LUCK RD STE 305
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3508
Mailing Address - Country:US
Mailing Address - Phone:301-552-1200
Mailing Address - Fax:
Practice Address - Street 1:1019 BRIGHTSEAT RD
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785-3738
Practice Address - Country:US
Practice Address - Phone:301-552-1200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAPITOL CARDIOLOGY ASSOCIATES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-08-14
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty