1962834317 NPI number — LOREDANA LICCHI CUNNINGHAM RD

Table of content: LOREDANA LICCHI CUNNINGHAM RD (NPI 1962834317)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962834317 NPI number — LOREDANA LICCHI CUNNINGHAM RD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CUNNINGHAM
Provider First Name:
LOREDANA
Provider Middle Name:
LICCHI
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962834317
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/07/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
47705 ALLEGHENY CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POTOMAC FALLS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20165-4705
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-989-0418
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1850 TOWN CENTER PKWY
Provider Second Line Business Practice Location Address:
SUITE 412
Provider Business Practice Location Address City Name:
RESTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20190-3219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-689-9108
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/07/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 896697 . This is a "ACADEMY OF NUTRITION AND DIETETICS MEMBER NUMBER" identifier . This identifiers is of the category "OTHER".




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