Provider Demographics
NPI:1760541460
Name:CAPITAL DIGESTIVE CARE ,LLC
Entity Type:Organization
Organization Name:CAPITAL DIGESTIVE CARE ,LLC
Other - Org Name:GASTROINTESTINAL & LIVER SPECIALIST 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 1:5839 HARBOUR VIEW BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435
Practice Address - Country:US
Practice Address - Phone:757-483-6100
Practice Address - Fax:757-483-2203
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAPITAL DIGESTIVE CARE, LLC - GLST
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-08
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA541870984OtherHEALTH NETWORK
541870984006OtherCHAMPUS
C13214OtherRR GROUP
005818281OtherFIRST HEALTH
314223OtherMAMSI OPT CHOICE
394398OtherANTHEM HBV
100000219OtherTRAILBLAZERS
110007207OtherTRAILBLAZERS
394397OtherANTHEM HBV
541870984028OtherCIGNA
311323OtherMAMSI OPT CHOICE
005818290OtherFIRST HEALTH
110175152OtherTRAVELERS RR MEDICARE
209382OtherANTHEM OBICI
25098OtherSENTARA OPTIMA
25106OtherSENTARA OPTIMA
209381OtherANTHEM OBICI
394398OtherANTHEM HBV
C13214OtherRR GROUP
311323OtherMAMSI OPT CHOICE