Basic Information
| Provider Information | |||||||||
| NPI: | 1275541013 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CAPITAL PALLIATIVE CARE CONSULTANTS, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PALLIATIVE CARE ASSOCIATES | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3180 FAIRVIEW PARK DRIVE | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | FALLS CHURCH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220424516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7035382043 | ||||||||
| FaxNumber: | 7038527389 | ||||||||
| Practice Location | |||||||||
| Address1: | 3180 FAIRVIEW PARK DRIVE | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | FALLS CHURCH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220424516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7035382043 | ||||||||
| FaxNumber: | 7038527389 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2006 | ||||||||
| LastUpdateDate: | 11/10/2022 | ||||||||
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| AuthorizedOfficialLastName: | OTOOLE | ||||||||
| AuthorizedOfficialFirstName: | COLLEEN | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR, PRACTICE MANAGEMENT | ||||||||
| AuthorizedOfficialTelephone: | 7035316209 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 11/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QH0002X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Hospice and Palliative Medicine | 207RH0002X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hospice and Palliative Medicine |
No ID Information.