Provider Demographics
NPI:1699963157
Name:CAPITAL PODIATRY ASSOCIATES PC
Entity type:Organization
Organization Name:CAPITAL PODIATRY ASSOCIATES PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:LELAND
Authorized Official - Middle Name:T
Authorized Official - Last Name:GILMORE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:703-560-3773
Mailing Address - Street 1:8101 HINSON FARM RD STE 301
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-3405
Mailing Address - Country:US
Mailing Address - Phone:703-560-3773
Mailing Address - Fax:703-799-0050
Practice Address - Street 1:8101 HINSON FARM RD STE 301
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306
Practice Address - Country:US
Practice Address - Phone:703-560-3773
Practice Address - Fax:703-799-0050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAT95949OtherUPIN
VAA729 0001OtherCAREFIRST/ BCBS
VA009302867Medicaid
DC010837200Medicaid
1235135815OtherINDIVIDUAL NPI/ L.GILMORE
VA480008618OtherRAILROAD MEDICARE
VA290062OtherANTHEM
DC010837200Medicaid
VA009302867Medicaid