Organization
BLUE MANTLE MEDICINE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SITA CANADY (MD)
(540) 645-1856
Entity
Organization
Contact information
Practice address
4001 FAIR RIDGE DR STE 305, FAIRFAX, VA 22033-2917
(540) 701-4767
(703) 520-9880
Mailing address
4001 FAIR RIDGE DR STE 305, FAIRFAX, VA 22033-2917
(540) 701-4767
(703) 520-9880
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Enumeration date
03/13/2023
Last updated
03/13/2023
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