Healthcare Provider Details

I. General information

NPI: 1700958410
Provider Name (Legal Business Name): CAPITOL PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11601 ROBIOUS RD
MIDLOTHIAN VA
23113-5605
US

IV. Provider business mailing address

11601 ROBIOUS RD
MIDLOTHIAN VA
23113-5605
US

V. Phone/Fax

Practice location:
  • Phone: 804-379-9494
  • Fax: 804-379-3702
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MONETTE W WOOD
Title or Position: PHYSICIAN PRESIDENT
Credential: MD
Phone: 804-379-9494