MD Nutrition and Lifestyle, LLC

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

L002913 Issued in NC

Legal business name

MD NUTRITION AND LIFESTYLE, LLC

Practice address

5901 Kingstowne Village Pkwy
Suite 300
Kingstowne, VA 22315

Phone

(860) 796-1930

NPI assigned

Feb 12, 2018

Last updated

Feb 12, 2018By 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

Miss Mara Michele Davis, MS, RD, CDN, LPNNPI 1790076883

Title

Clinical Dietitan

Phone

(860) 796-1930

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in DC

Enrollment records 1

Practitioners 2

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.

• Mara Davis, MS, RD, CD-N, LDN

  • Registered Dietitian
  • Alexandria, VA
  • NPI 1790076883

  DC

  Medicare reassignment Authorized official
• Arleija Williams, MS, RDN

  • Registered Dietitian
  • Brambleton, VA
  • NPI 1891664223

  Dietitian, Registered

  NPD (past)

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

{
    "created_epoch": "1518393600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1518393600000",
    "number": "1972002301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "95 BRETTON RD",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "06457",
            "telephone_number": "860-796-1930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5901 KINGSTOWNE VILLAGE PKWY",
            "address_2": "SUITE 300",
            "city": "KINGSTOWNE",
            "state": "VA",
            "postal_code": "22315",
            "telephone_number": "860-796-1930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MD NUTRITION AND LIFESTYLE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-12",
        "last_updated": "2018-02-12",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "MARA",
        "authorized_official_middle_name": "MICHELE",
        "authorized_official_title_or_position": "CLINICAL DIETITAN",
        "authorized_official_telephone_number": "860-796-1930",
        "authorized_official_name_prefix": "Miss",
        "authorized_official_credential": "MS, RD, CDN, LPN"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "CT",
            "license": "001415",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NC",
            "license": "L002913",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stacey Anne Lawson, LPC
• Loudoun Medical Group, PC (Kingstowne Urgent Care)
• Loudoun Medical Group, PC (Kingstowne Internal Medicine)
• Seferino Martinez Jr., LPC
• Shannon Herzog McGee, LPC
• Mia Health Inc.
• Yvonne Osei, PMHNP-BC
• Joyce Margaret Stuart, RN, MS, BC
• Cheryll Lynn Zellmer, RN

• Registered Dietitian in Kingstowne, VA
• Providers in Kingstowne, VA by specialty
• Registered Dietitian in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.