Basic Information
| Provider Information | |||||||||
| NPI: | 1164683181 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CAPITAL DIGESTIVE CARE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10770 COLUMBIA PIKE STE 400 | ||||||||
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| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209014462 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2404855210 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10801 LOCKWOOD DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209011556 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3015932002 | ||||||||
| FaxNumber: | 3015934781 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2008 | ||||||||
| LastUpdateDate: | 12/30/2020 | ||||||||
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| AuthorizedOfficialLastName: | HARLEN | ||||||||
| AuthorizedOfficialFirstName: | KEVIN | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF OPERATING OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 2404855210 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 12/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.