Provider Demographics
NPI:1275541013
Name:CAPITAL PALLIATIVE CARE CONSULTANTS, LLC
Entity Type:Organization
Organization Name:CAPITAL PALLIATIVE CARE CONSULTANTS, LLC
Other - Org Name:PALLIATIVE CARE ASSOCIATES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR, PRACTICE MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:OTOOLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-531-6209
Mailing Address - Street 1:3180 FAIRVIEW PARK DRIVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-4516
Mailing Address - Country:US
Mailing Address - Phone:703-538-2043
Mailing Address - Fax:703-852-7389
Practice Address - Street 1:3180 FAIRVIEW PARK DRIVE
Practice Address - Street 2:SUITE 500
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-4516
Practice Address - Country:US
Practice Address - Phone:703-538-2043
Practice Address - Fax:703-852-7389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Multi-Specialty
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC10857Medicare UPIN
DCG00802Medicare ID - Type UnspecifiedMETRO DC NUMBER