Provider Demographics
NPI:1538371737
Name:CAPITAL MEDICAL ASSOCIATES
Entity type:Organization
Organization Name:CAPITAL MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:R
Authorized Official - Last Name:LEARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-587-3003
Mailing Address - Street 1:1235 WHITEHORSE MERCERVILLE RD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-3810
Mailing Address - Country:US
Mailing Address - Phone:609-587-3003
Mailing Address - Fax:609-587-4512
Practice Address - Street 1:1235 WHITEHORSE MERCERVILLE RD
Practice Address - Street 2:SUITE 306
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-3810
Practice Address - Country:US
Practice Address - Phone:609-587-3003
Practice Address - Fax:609-587-4512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02992000207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ035720Medicare PIN