Basic Information
| Provider Information | |||||||||
| NPI: | 1972816429 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CAPTIAL AREA PEDIATRICS, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14 PIDGEON HILL DRIVE | ||||||||
| Address2: | #130 | ||||||||
| City: | STERLING | ||||||||
| State: | VA | ||||||||
| PostalCode: | 20165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7034441144 | ||||||||
| FaxNumber: | 7034446679 | ||||||||
| Practice Location | |||||||||
| Address1: | 14 PIDGEON HILL DRIVE | ||||||||
| Address2: | #130 | ||||||||
| City: | STERLING | ||||||||
| State: | VA | ||||||||
| PostalCode: | 20165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7034441144 | ||||||||
| FaxNumber: | 7034446679 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2010 | ||||||||
| LastUpdateDate: | 07/26/2010 | ||||||||
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| AuthorizedOfficialLastName: | WATTS | ||||||||
| AuthorizedOfficialFirstName: | ELIZABETH | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF OPERATING OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 7033595160 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CAPTIAL AREA PEDIATRICS, INC | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.