Healthcare Provider Details

I. General information

NPI: 1912769795
Provider Name (Legal Business Name): CALEB SPROUSE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: CALEB MICHAEL SPROUSE MD

II. Dates (important events)

Enumeration Date: 01/26/2024
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 DEWITT LOOP
FORT BELVOIR VA
22060-5285
US

IV. Provider business mailing address

414 QUEEN ST
ALEXANDRIA VA
22314-2621
US

V. Phone/Fax

Practice location:
  • Phone: 571-231-1803
  • Fax:
Mailing address:
  • Phone: 423-712-0558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0101286706
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: