| Capital Center For Functional Medicine Llc | |
|
4701 Sangamore Rd Ste N270 Bethesda MD 20816-2528 | |
| (240) 507-5110 | |
| Not Available |
| Full Name | Capital Center For Functional Medicine Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 4701 Sangamore Rd Ste N270, Bethesda, Maryland |
| Authorized Official Name and Position | Andrew Wong (FOUNDER AND MEDICAL DIRECTOR) |
| Authorized Official Contact | 3018922658 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Capital Center For Functional Medicine Llc 416 Green Pasture Dr Rockville MD 20852-4233 Ph: (301) 892-2658 | Capital Center For Functional Medicine Llc 4701 Sangamore Rd Ste N270 Bethesda MD 20816-2528 Ph: (240) 507-5110 |
| NPI Number | 1922496462 |
|---|---|
| Provider Enumeration Date | 01/07/2015 |
| Last Update Date | 12/16/2022 |
| Medicare PECOS PAC ID | 8820318520 |
|---|---|
| Medicare Enrollment ID | O20150520002003 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922496462 | NPI | - | NPPES |
| 014051100 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | D66066 (Maryland) | Primary |
| Provider Name | Andrew L Wong |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1639213150 PECOS PAC ID: 1254423411 Enrollment ID: I20070817000605 |
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