Provider Demographics
NPI:1487183075
Name:CAPITAL ORTHOPAEDIC SPECIALISTS LLC
Entity type:Organization
Organization Name:CAPITAL ORTHOPAEDIC SPECIALISTS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CAMILLE
Authorized Official - Middle Name:R
Authorized Official - Last Name:BASH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-552-8028
Mailing Address - Street 1:PO BOX 418871
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-8871
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8116 GOOD LUCK RD STE 210
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3508
Practice Address - Country:US
Practice Address - Phone:240-965-4406
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAPITAL ORTHOPAEDIC SPECIALISTS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-06-07
Last Update Date:2017-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX3601133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty