Provider Demographics
NPI:1659563799
Name:CAPITAL DIGESTIVE CARE LLC
Entity Type:Organization
Organization Name:CAPITAL DIGESTIVE CARE LLC
Other - Org Name:GASTROINTESTINAL AND LIVER SPECIALISTS OF TIDEWATER, PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:WEINSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-485-5210
Mailing Address - Street 1:10770 COLUMBIA PIKE STE 400
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-4462
Mailing Address - Country:US
Mailing Address - Phone:240-485-5210
Mailing Address - Fax:
Practice Address - Street 1:885 KEMPSVILLE RD
Practice Address - Street 2:SUITE 114
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3800
Practice Address - Country:US
Practice Address - Phone:757-466-0165
Practice Address - Fax:757-466-7296
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAPITAL DIGESTIVE CARE, LLC- DIGESTIVE AND LIVER DISEASE SPECIALISTS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-13
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAE90748Medicare UPIN
VAH37467Medicare UPIN
VAQ47342Medicare UPIN
VAC05453Medicare PIN
VAD80373Medicare UPIN
VAG54390Medicare UPIN
VAP30058Medicare UPIN
VAS27413Medicare UPIN
VAH68439Medicare UPIN
VAI26166Medicare UPIN
VAP58000Medicare UPIN
VAB09598Medicare UPIN
VAF30482Medicare UPIN
VAS60586Medicare UPIN
VAQ26081Medicare UPIN