Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Blue Mantle Medicine PLLC

Organization Pediatrics Physician · NPI 1417658980

Blue Mantle Medicine PLLC is a Pediatrics Physician in Fairfax, Virginia. Registered with an NPI since 2023.

In the registry since
2023
What do these letters mean?
PLLC — Professional limited liability company
A form of business registration, not a clinical qualification.

See every abbreviation used in this directory →

Practice location Address checks out

4001 Fair Ridge Dr Ste 305
Fairfax, VA 22033-2917
Phone: (540) 701-4767
Fax: (703) 520-9880
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Pediatrics Physician (primary) Taxonomy 208000000X

Record details

NPI number1417658980
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Sita Canady — Md · (540) 645-1856
NPI enumeratedMarch 13, 2023
Last updated in NPPESMarch 13, 2023
Certification dateMarch 13, 2023
Mailing address4001 Fair Ridge Dr Ste 305, Fairfax, VA 22033-2917

Other providers in Fairfax