Blue Mantle Medicine Pllc

NPI #1417658980 in Fairfax, Virginia

Provider Information

NPI Number: 1417658980
Entity Type: Organization
Organization Name: Blue Mantle Medicine Pllc
Primary Specialty: Pediatrics
Enumeration Date: Mar 13, 2023
Last Updated: Mar 13, 2023

Practice Location

Address: 4001 FAIR RIDGE DR STE 305
City: Fairfax
State: Virginia
ZIP Code: 22033-2917
Phone: (540) 701-4767

Authorized Official

Name: SITA CANADY
Title: MD
Phone: (540) 645-1856

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Pediatrics	208000000X	Primary

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