Provider Demographics
NPI:1699868463
Name:CAPITOL MEDICAL ASSOCIATES,LLC
Entity type:Organization
Organization Name:CAPITOL MEDICAL ASSOCIATES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GAVIN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:BAUMGARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:614-595-1055
Mailing Address - Street 1:PO BOX 634230
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-0001
Mailing Address - Country:US
Mailing Address - Phone:614-595-1055
Mailing Address - Fax:614-873-2040
Practice Address - Street 1:6674 WESTON CIR W
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-7901
Practice Address - Country:US
Practice Address - Phone:614-595-1055
Practice Address - Fax:614-873-2040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2421749Medicaid
OHCA9336581Medicare UPIN