Provider Demographics
NPI:1720126121
Name:CAPITAL PODIATRY ASSOCIATES
Entity type:Organization
Organization Name:CAPITAL PODIATRY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIARIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ARNOLD
Authorized Official - Middle Name:S
Authorized Official - Last Name:RAVICK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:202-223-0500
Mailing Address - Street 1:1145 19TH ST NW
Mailing Address - Street 2:SUITE 409
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-3701
Mailing Address - Country:US
Mailing Address - Phone:202-223-0500
Mailing Address - Fax:202-296-2531
Practice Address - Street 1:1145 19TH ST NW
Practice Address - Street 2:SUITE 409
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-3701
Practice Address - Country:US
Practice Address - Phone:202-223-0500
Practice Address - Fax:202-296-2531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPO326213ES0103X
DCPO564213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCCM9209OtherRR GROUP PROVIDER #
DCT30890Medicare UPIN
DCCM9209OtherRR GROUP PROVIDER #
DC156011Medicare PIN