Provider Demographics
NPI:1043823420
Name:KOPF, GRACE LANGE (RD)
Entity Type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:LANGE
Last Name:KOPF
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MISS
Other - First Name:GRACE
Other - Middle Name:VIRGINIA
Other - Last Name:LANGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:4318 OLD HUNDRED RD RM E
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-4231
Mailing Address - Country:US
Mailing Address - Phone:048-592-0095
Mailing Address - Fax:804-655-6183
Practice Address - Street 1:6953 FIELDWOOD RD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-3832
Practice Address - Country:US
Practice Address - Phone:804-437-2889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-26
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA920888133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty