Healthcare Provider Details

I. General information

NPI: 1285490805
Provider Name (Legal Business Name): KENDALL MACKINTOSH MS, CNS, LDN, INHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2024
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 ROBINWOOD RD
BETHESDA MD
20817-6115
US

IV. Provider business mailing address

6200 ROBINWOOD RD
BETHESDA MD
20817-6115
US

V. Phone/Fax

Practice location:
  • Phone: 240-674-7187
  • Fax:
Mailing address:
  • Phone: 240-674-7187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberDX7060
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: