Blue Mantle Medicine PLLC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

BLUE MANTLE MEDICINE PLLC

Practice address

4001 Fair Ridge Dr Ste 305
Fairfax, VA 22033-2917

Phone

(540) 701-4767

Fax

(703) 520-9880

NPI assigned

Mar 13, 2023

Last updated

Mar 13, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Sita CanadyNPI 1407948953

Title

MD

Phone

(540) 645-1856

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Sita S. Canady, M.D.

  • Pediatrics Physician
  • Fairfax, VA
  • NPI 1407948953
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1678665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678665600000",
    "number": "1417658980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4001 FAIR RIDGE DR STE 305",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220332917",
            "telephone_number": "540-701-4767",
            "fax_number": "703-520-9880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4001 FAIR RIDGE DR STE 305",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220332917",
            "telephone_number": "540-701-4767",
            "fax_number": "703-520-9880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE MANTLE MEDICINE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-13",
        "last_updated": "2023-03-13",
        "certification_date": "2023-03-13",
        "status": "A",
        "authorized_official_last_name": "CANADY",
        "authorized_official_first_name": "SITA",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "540-645-1856"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Richard Allen Blosser Jr., M.D.
• Blue ABA Center LLC
• Blue Angels Health Care Solutions
• Blue Gems ABA Therapy VA LLC
• Blue Heart LLC
• Blue Ridge Home Health Care LLC
• Blue Star Medical Transportation Inc.
• Bluemont Plastic Surgery, PC
• Lindsey Jo Blythe, M.S., CCC-SLP
• BNM, Inc. (My Kid's Pediatrics and Adolescent Care)

• Pediatrics Physician in Fairfax, VA
• Providers in Fairfax, VA by specialty
• Pediatrics Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.