Healthcare Provider Details

I. General information

NPI: 1760541460
Provider Name (Legal Business Name): CAPITAL DIGESTIVE CARE ,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5839 HARBOUR VIEW BLVD SUITE 200
SUFFOLK VA
23435
US

IV. Provider business mailing address

10770 COLUMBIA PIKE STE 400
SILVER SPRING MD
20901-4462
US

V. Phone/Fax

Practice location:
  • Phone: 757-483-6100
  • Fax: 757-483-2203
Mailing address:
  • Phone: 240-485-5210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY SHORT
Title or Position: CEO
Credential:
Phone: 757-803-6483