Nutrgen LLC

Primary specialty

NutritionistTaxonomy code 133N00000X

License

DX4369 Issued in MD

Legal business name

NUTRGEN LLC

Practice address

13110 Glen Rd
North Potomac, MD 20878-8852

Phone

(301) 703-9923

NPI assigned

Mar 28, 2018

Organization subpart

No

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

Authorized official

Name

Mrs. Eva El-Khatib, CNS

Title

Program Director

Phone

(301) 703-9923

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1522195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560211200000",
    "number": "1063917433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13110 GLEN RD",
            "city": "NORTH POTOMAC",
            "state": "MD",
            "postal_code": "208788852",
            "telephone_number": "301-703-9923"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13110 GLEN RD",
            "city": "NORTH POTOMAC",
            "state": "MD",
            "postal_code": "208788852",
            "telephone_number": "301-703-9923"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NUTRGEN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-28",
        "last_updated": "2019-06-11",
        "status": "A",
        "authorized_official_last_name": "EL-KHATIB",
        "authorized_official_first_name": "EVA",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "301-703-9923",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CNS"
    },
    "taxonomies": [
        {
            "code": "133N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nutritionist",
            "state": "MD",
            "license": "DX4369",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MARYLAND BOARD OF DIETETIC PRACTICE- FOR EVA EL-KHATIB",
            "identifier": "DX4369",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Nutritionist in North Potomac, MD
• Providers in North Potomac, MD by specialty
• Nutritionist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.