Healthcare Provider Details

I. General information

NPI: 1659918381
Provider Name (Legal Business Name): CAPITAL CARING ADVANCED ILLNESS SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2019
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3180 FAIRVIEW PARK DRIVE SUITE 600
FALLS CHURCH VA
22042
US

IV. Provider business mailing address

3180 FAIRVIEW PARK DRIVE SUITE 600
FALLS CHURCH VA
22042
US

V. Phone/Fax

Practice location:
  • Phone: 703-712-4874
  • Fax:
Mailing address:
  • Phone: 703-712-4874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CRYSTAL BUCCIARELLI
Title or Position: VP, LEGAL SERVICES
Credential:
Phone: 813-871-8075