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Contact Information

MD NUTRITION AND LIFESTYLE, LLC
5901 KINGSTOWNE VILLAGE PKWY
SUITE 300
KINGSTOWNE, VA22315
 Phone: 860-796-1930
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dietitian, Registered

133V00000X 71 Registered Dietitian or Nutrition Professional
Indicates primary specialty

NPI Profile & details for MD NUTRITION AND LIFESTYLE, LLC

NPI # 1972002301
LBN Legal business name MD NUTRITION AND LIFESTYLE, LLC
Authorized official MARA DAVIS - (CLINICAL DIETITAN)
Entity Organization
Organization subpart 1 No
Enumeration date 02/12/2018
Last updated 02/12/2018 - About 8 years ago
Identifiers
CT License # 001415
NC License # L002913
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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