Healthcare Provider Details

I. General information

NPI: 1225341779
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

12950 HIGHLAND CROSSING DRIVE SUITE H
HERNDON VA
20171
US

IV. Provider business mailing address

12950 HIGHLAND CROSSING DRIVE SUITE H
HERNDON VA
20171
US

V. Phone/Fax

Practice location:
  • Phone: 703-860-4200
  • Fax: 703-860-1528
Mailing address:
  • Phone: 703-860-4200
  • Fax: 703-860-1528

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 OFFICER
Credential: MD
Phone: 703-359-5160