Provider Demographics
NPI:1912193350
Name:CAPITAL DIGESTIVE CARE, LLC
Entity Type:Organization
Organization Name:CAPITAL DIGESTIVE CARE, LLC
Other - Org Name:CAPITAL DIGESTIVE CARE- PRINCESS ANNE
Other - Org Type:Doing Business As
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 1:1925 GLENN MITCHELL DR
Practice Address - Street 2:SUITE 102
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-0170
Practice Address - Country:US
Practice Address - Phone:757-464-1644
Practice Address - Fax:757-363-1071
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAPITAL DIGESTIVE CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-19
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC05905Medicare PIN
VAC06258Medicare PIN
VAC09823Medicare PIN