Healthcare Provider Details

I. General information

NPI: 1245543792
Provider Name (Legal Business Name): CAPTIAL AREA PEDIATRICS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2010
Last Update Date: 07/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43480 YUKON DRIVE SUITE 206
ASHBURN VA
20147
US

IV. Provider business mailing address

43480 YUKON DRIVE SUITE 206
ASHBURN VA
20147
US

V. Phone/Fax

Practice location:
  • Phone: 703-723-3201
  • Fax: 703-729-2736
Mailing address:
  • Phone: 703-723-3201
  • Fax: 703-729-2736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH H WATTS
Title or Position: CHIEF OPERATING OFFICERV
Credential: MD
Phone: 703-359-5160