Provider Demographics
NPI:1639316318
Name:CAPITAL DIGESTIVE CARE ,LLC
Entity type:Organization
Organization Name:CAPITAL DIGESTIVE CARE ,LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RODERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:KREISBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-335-2899
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:124-048-5521
Mailing Address - Fax:757-534-7708
Practice Address - Street 1:11803 JEFFERSON AVE
Practice Address - Street 2:STE 230
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-2565
Practice Address - Country:US
Practice Address - Phone:757-534-7701
Practice Address - Fax:757-534-7708
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAPITAL DIGESTIVE CARE ,LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-16
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101224242174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty