1760541460 NPI number — CAPITAL DIGESTIVE CARE ,LLC

Table of content: (NPI 1760541460)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760541460 NPI number — CAPITAL DIGESTIVE CARE ,LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAPITAL DIGESTIVE CARE ,LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760541460
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/07/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10770 COLUMBIA PIKE STE 400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SILVER SPRING
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20901-4462
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-485-5210
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5839 HARBOUR VIEW BLVD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
SUFFOLK
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-483-6100
Provider Business Practice Location Address Fax Number:
757-483-2203
Provider Enumeration Date:
12/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NEUMANN
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT & CHIEF STRATEGY OFFICER
Authorized Official Telephone Number:
757-483-6100

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 005818290 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100000219 . This is a "TRAILBLAZERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 394397 . This is a "ANTHEM HBV" identifier . This identifiers is of the category "OTHER".
  • Identifier: 209381 . This is a "ANTHEM OBICI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 311323 . This is a "MAMSI OPT CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 25098 . This is a "SENTARA OPTIMA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 541870984 . This is a "HEALTH NETWORK" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: C13214 . This is a "RR GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 005818281 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 110175152 . This is a "TRAVELERS RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 25106 . This is a "SENTARA OPTIMA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 541870984006 . This is a "CHAMPUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 541870984028 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 209382 . This is a "ANTHEM OBICI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 314223 . This is a "MAMSI OPT CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 110007207 . This is a "TRAILBLAZERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 394398 . This is a "ANTHEM HBV" identifier . This identifiers is of the category "OTHER".




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