Healthcare Provider Details

I. General information

NPI: 1518501303
Provider Name (Legal Business Name): KELLY MAGOFFIN MS, RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2019
Last Update Date: 11/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 IRVING ST NW STE 301
WASHINGTON DC
20010-3017
US

IV. Provider business mailing address

18360 MID OCEAN PL
LEESBURG VA
20176-7451
US

V. Phone/Fax

Practice location:
  • Phone: 202-877-7788
  • Fax:
Mailing address:
  • Phone: 703-629-7495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI100000904
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: