Provider Demographics
NPI:1164870572
Name:REEDER, MADISON MARIE (BS, RDN)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:MARIE
Last Name:REEDER
Suffix:
Gender:F
Credentials:BS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4220 CAMPBELL AVE
Mailing Address - Street 2:APT. T810
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22206-3427
Mailing Address - Country:US
Mailing Address - Phone:610-334-6076
Mailing Address - Fax:
Practice Address - Street 1:2200 WILSON BLVD
Practice Address - Street 2:SUITE 412
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22201-3397
Practice Address - Country:US
Practice Address - Phone:571-317-1472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA86065379133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered