Basic Information
| Provider Information | |||||||||
| NPI: | 1720468663 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CAPITAL ORTHOPAEDIC SPECIALISTS LLC | ||||||||
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| OtherOrganizationName: | COS LLC PT BOWIE | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4000 MITCHELLVILLE RD | ||||||||
| Address2: | SUITE B116 | ||||||||
| City: | BOWIE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207163104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3014644503 | ||||||||
| FaxNumber: | 3018059791 | ||||||||
| Practice Location | |||||||||
| Address1: | 4000 MITCHELLVILLE RD | ||||||||
| Address2: | SUITE B116 | ||||||||
| City: | BOWIE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207163104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3014644503 | ||||||||
| FaxNumber: | 3018059791 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2015 | ||||||||
| LastUpdateDate: | 12/10/2015 | ||||||||
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| AuthorizedOfficialLastName: | CROWE | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 3015991000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 22231 | MD | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225X00000X | 03020 | MD | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 235Z00000X | 06902 | MD | N | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 261QP2000X | D0022407 | MD | N | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy | 207X00000X | D0022407 | MD | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.