Healthcare Provider Details

I. General information

NPI: 1891885992
Provider Name (Legal Business Name): KELLI MICHELE METZGER MS, RD, LDN, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 PENNSYLVANIA AVE, NW, SUITE 4-417 GW HEART AND VASCULAR INSTITUTE
WASHINGTON DC
20037
US

IV. Provider business mailing address

5911 LEBANON LN
ELKRIDGE MD
21075-5142
US

V. Phone/Fax

Practice location:
  • Phone: 202-741-2579
  • Fax:
Mailing address:
  • Phone: 919-986-2508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDO2218
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberD1100000590
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: