Basic Information
| Provider Information | |||||||||
| NPI: | 1184360950 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CAPITAL WOMENS CARE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8110 MAPLE LAWN BLVD STE 235 | ||||||||
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| City: | FULTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207592694 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3013408339 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1715 TWIN SPRINGS RD STE 105 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212273565 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109461116 | ||||||||
| FaxNumber: | 4109466336 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2022 | ||||||||
| LastUpdateDate: | 05/05/2022 | ||||||||
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| AuthorizedOfficialLastName: | ALLRED | ||||||||
| AuthorizedOfficialFirstName: | RENEE | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF CREDENTIALING | ||||||||
| AuthorizedOfficialTelephone: | 3013408339 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CAPITAL WOMENS CARE LLC | ||||||||
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| NPICertificationDate: | 05/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No ID Information.