Provider Demographics
NPI:1215540323
Name:MCGRATH, KELLY (MS, RD, CNSC, LDN)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:MCGRATH
Suffix:
Gender:F
Credentials:MS, RD, CNSC, LDN
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:MORROW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, LDN
Mailing Address - Street 1:1565 EFFORD RD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-3216
Mailing Address - Country:US
Mailing Address - Phone:520-971-9303
Mailing Address - Fax:
Practice Address - Street 1:22 S ATHOL AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-3405
Practice Address - Country:US
Practice Address - Phone:410-947-3052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX-3126133VN1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1101XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Gerontological