Provider Demographics
NPI:1902930720
Name:CAPITAL CARDIOVASCULAR SURGERY PA
Entity Type:Organization
Organization Name:CAPITAL CARDIOVASCULAR SURGERY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:G
Authorized Official - Last Name:CHAUDHRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-787-1772
Mailing Address - Street 1:3214 CHARLES B ROOT WYND
Mailing Address - Street 2:203
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-5440
Mailing Address - Country:US
Mailing Address - Phone:919-787-1772
Mailing Address - Fax:
Practice Address - Street 1:3214 CHARLES B ROOT WYND
Practice Address - Street 2:203
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-5440
Practice Address - Country:US
Practice Address - Phone:919-787-1772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25784208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0135LOtherBCS NC
NC890135LMedicaid
NC=========OtherEIN
NCE14227Medicare UPIN
NC=========OtherEIN
NC205378BMedicare ID - Type UnspecifiedMEDICARE GROUP