# CAPITAL CENTER FOR FUNCTIONAL MEDICINE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1922496462
- **Authorized official:** ANDREW WONG MD (FOUNDER AND MEDICAL DIRECTOR)
- **Authorized official phone:** (301) 892-2658

## Contact information

- **Practice address:** 4701 SANGAMORE RD STE N270, BETHESDA, MD 20816-2528
- **Practice address phone:** (240) 507-5110
- **Mailing address:** 416 GREEN PASTURE DR, ROCKVILLE, MD 20852-4233
- **Mailing address phone:** (301) 892-2658

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | D66066 | MD | Yes |

## Other

- **Enumeration date:** 01/07/2015
- **Last updated:** 12/06/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 014051100 | — | MD |