Md Nutrition And Lifestyle, Llc is a medicare enrolled "Dietitian, Registered" provider in Kingstowne, Virginia. Their current practice location is
5901 Kingstowne Village Pkwy, Suite 300, Kingstowne, Virginia. You can reach out to their office (for appointments etc.) via phone at
(860) 796-1930.
Md Nutrition And Lifestyle, Llc is licensed to practice in North Carolina (license number L002913) and it also participates in the medicare program. Md Nutrition And Lifestyle, Llc
is enrolled with medicare and should accept medicare assignments and since they are enrolled in medicare, they may order Medicare Part D Prescription drugs, if eligible. The facility's NPI Number is 1972002301.
Healthcare Provider's Profile
| Full Name | Md Nutrition And Lifestyle, Llc |
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| Type | Facility |
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| Speciality | Dietitian, Registered |
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| Location | 5901 Kingstowne Village Pkwy, Kingstowne, Virginia |
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| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1972002301
- Provider Enumeration Date: 02/12/2018
- Last Update Date: 02/12/2018
Medicare PECOS Information:
- PECOS PAC ID: 5799025573
- Enrollment ID: O20190313001950
Medical Identifiers
Medical identifiers for Md Nutrition And Lifestyle, Llc such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1972002301 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 133V00000X | Dietitian, Registered | 001415 (Connecticut) | Secondary |
| 133V00000X | Dietitian, Registered | L002913 (North Carolina) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works.
Md Nutrition And Lifestyle, Llc acts as a billing entity for following providers:
| Provider Name | Mara M Davis |
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| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
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| Provider Identifiers | NPI Number: 1790076883
PECOS PAC ID: 6406024017
Enrollment ID: I20190313002111 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Md Nutrition And Lifestyle, Llc is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Md Nutrition And Lifestyle, Llc
95 Bretton Rd,
Middletown, CT 06457
Ph: (860) 796-1930 | Md Nutrition And Lifestyle, Llc
5901 Kingstowne Village Pkwy, Suite 300,
Kingstowne, VA 22315
Ph: (860) 796-1930 |
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