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General NPI Number Information
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NPI Number | 1790076883
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Entity Type | Individual
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Provider Name | MARA DAVIS MS, RD, CD-N, LDN
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Gender | Female
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Dates
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Enumeration Date | 04/25/2011
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Last Update Date | 09/24/2018
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Provider Practice Location Address
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Address Line | 5901 KINGSTOWNE VILLAGE PKWY STE 300
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City | ALEXANDRIA
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State | VA
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Zip | 22315-5883
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Country | US
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Telephone | 860-796-1930
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Fax |
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Provider Business Mailing Address
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Address Line | 95 BRETTON RD
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City | MIDDLETOWN
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State | CT
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Zip | 06457-4111
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Country | US
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Telephone | 860-796-1930
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Fax | 860-545-3765
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 001415
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 919705
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 919705
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License Number State | VA
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