MEDICARE: DIETETIC CONSULTANTS OF NORTHERN VIRGINIA, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	2004009119	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G02785	OTHER		MEDICARE PTAN

General Provider Information

NPI Number	:	1831379882
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIETETIC CONSULTANTS OF NORTHERN VIRGINIA, LLC

Provider Business Mailing Address
First Line	:	5412 CASTLE BAR LN
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22315-5519
Country	:	US
Telephone Number	:	703-879-5160
Fax Number	:

Provider Business Practice Location Address
First Line	:	2121 EISENHOWER AVE
Second Line	:	SUITE 200
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-4698
Country	:	US
Telephone Number	:	703-519-0901
Fax Number	:	703-519-0902

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BONITA LILLIE
Credential	:	RD, LD
Telephone Number	:	703-879-5160

Provider Enumeration Date	:	11/07/2007
Last Update Date	:	09/18/2008

Similar Medicare Providers

1932057676 — SHALOM LIFE CARE SOLUTION LLC
Practice Location Address:

2121 EISENHOWER AVE STE 218
ALEXANDRIA, VA
22314-4698

Practice Phone: 202-560-3558
Practice Fax:

1669573036 — DR. DAVID C. BISSETTE PSY.D.
Practice Location Address:

2121 EISENHOWER AVE , SUITE #402
ALEXANDRIA, VA
22314-4698

Practice Phone: 703-705-6161
Practice Fax: 703-684-0046

1740342898 — MS. GAIL F MCCURRY MSW, LCSW
Practice Location Address:

2121 EISENHOWER AVE , SUITE 402
ALEXANDRIA, VA
22314-4698

Practice Phone: 703-969-8874
Practice Fax:

1538299532 — DR. MONICA ANNETTE ROBB PH.D.
Practice Location Address:

2121 EISENHOWER AVE STE 222
ALEXANDRIA, VA
22314-4698

Practice Phone: 703-944-0422
Practice Fax:

1962692814 — LYNLEE RENEE TANNER STAPLETON PH.D.
Practice Location Address:

2121 EISENHOWER AVE , STE 230
ALEXANDRIA, VA
22314-4698

Practice Phone: 202-999-9999
Practice Fax:

1134305857 — BONITA LILLIE RD
Practice Location Address:

2121 EISENHOWER AVE , SUITE 200
ALEXANDRIA, VA
22314-4698

Practice Phone: 703-519-0901
Practice Fax: 703-519-0902

Directions to “DIETETIC CONSULTANTS OF NORTHERN VIRGINIA, LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.